Preamble

The House met at half-past Two o'clock

PRAYERS

[MR. SPEAKER in the Chair]

Royal Assent

Mr. Speaker: I have to notify the House, in accordance with the Royal Assent Act 1967, that the Queen has signified Her Royal Assent to the following Act:
Lloyds Bowmaker Act 1983.

PRIVATE BUSINESS

BRITISH RAILWAYS BILL

NOTTINGHAMSHIRE COUNTY COUNCIL BILL
[Lords]

Orders for consideration, as amended, read.

To be considered upon Thursday 3 November.

SHREWSBURY AND ATCHAM BOROUGH COUNCIL BILL [Lords]

TEES AND HARTLEPOOL PORT AUTHORITY BILL

DARTFORD TUNNEL BILL [Lords]

Orders for Second reading read.

To be read a Second time upon Thursday 3 November.

Oral Answers to Questions — NATIONAL FINANCE

Economic Recovery

Dr. Godman: asked the Chancellor of the Exchequer what evidence he has of sustained recovery in the economy.

Mr. Dubs: asked the Chancellor of the Exchequer what is the evidence of economic recovery.

The Chancellor of the Exchequer (Mr. Nigel Lawson): For the past two years or more GDP has been growing at a rate of 2·5 to 3 per cent. a year. This is the consequence of sound monetary and fiscal policies, which have brought down inflation and interest rates.

Dr. Godman: Will the Chancellor of the Exchequer assure the House that unemployed people and those in need will benefit from any hoped-for prosperity, which presumably will accompany the hoped-for economic recovery, particularly by a real increase in benefit levels?

Mr. Lawson: The whole nation will stand to benefit from the economic recovery. The level of unemployment is far from satisfactory, but I am sure the hon. Gentleman

will be pleased to know that figures for those in work—the total number of employees and the self-employed—for the second quarter of this year showed the first increase since the recession began.

Mr. Dubs: Does the Chancellor agree that the output measure is a more reliable indicator than GDP, which he has quoted, and that the output measure shows a much smaller rate of economic growth than the figure that he gave to the House? Is this not an example of the Chancellor juggling with the figures to persuade himself and the country that things are better than they are?

Mr. Lawson: On the contrary, it is a matter of regret that the hon. Gentleman should take such delight in trying to show that matters in this country are worse than they are. The figures which I quoted are the average of the output, expenditure and income measures. That is the basis upon which the Central Statistical Office has worked under the present Government, under the Labour Government and for as long as I can remember. It is not true to say that, over the period that I have mentioned, the output measure alone is the best indicator. The average measure is the best.

Mr. Beaumont-Dark: Will my right hon. Friend let us know what further ideas he has, so that this genuine recovery in demand is sustained? Will he keep capital expenditure, rather than revenue expenditure, foremost in his mind?

Mr. Lawson: Capital expenditure is very important and, happily, is increasing. If my hon. Friend is thinking in particular about public expenditure, I must tell him that it is a matter for my right hon. Friends, who are responsible for their Departments, to determine the priorities in their programmes between current and capital expenditure.

Dr. Bray: Does the Chancellor agree that, even on the average estimate, GDP has not yet recovered to the level in 1979 when the Government took office?

Mr. Lawson: It has not yet recovered to that level, although it has recovered to be close to that level. As the hon. Gentleman is aware, we have been going through the worst world recession since the 1930s. I am sure that if he is patient he will before long witness output that surpasses the previous highest level.

Mr. Silvester: Does my right hon. Friend believe that our economic recovery would be advanced by reducing public expenditure? If so, on what does he base that belief?

Mr. Lawson: I base my belief on that which is shared by most, if not all, of my right hon. and hon. Friends, including my hon. Friend the Member for Manchester, Withington (Mr. Silvester). An economy in which there are effective incentives is likely to do better than one in which there are inadequate incentives for earning, risk-taking and so on. To that end it is necessary to reduce the burden of taxation. That can be achieved responsibly only by very firm control of public expenditure.

Mr. Shore: On the assumption that the lines of communication between the United States Treasury and Great George street are more open than those between the State Department and the Foreign Office, will the right hon. Gentleman pay some attention to the fact that the rate of growth in the United States is now 8 per cent. per


annum, that unemployment is falling and that that happy state of affairs has been brought about simply because the United States Treasury has abandoned precisely the money supply measures and public expenditure restraints which the right hon. Gentleman constantly urges upon us? Does he agree that the real measure of growth is output, as my hon. Friend the Member for Battersea (Mr. Dubs) said? Is he aware that output is rising at a rate of 1.7 per cent. and that we are still 4 per cent. below the level that obtained at the 1979 general election?

Mr. Lawson: I understand from reading the newspapers that this might be the right hon. Gentleman's last appearance with his present duties. I have no means of knowing whether that is true, but if it is I should like to say that we shall all greatly miss his old world charm. It is clear that the performance of the American economy is due to its greater resilience and the fact that public expenditure, Government spending and taxation in the United States are a great deal lower than in Britain.

Falkland Islands

Mr. Dalyell: asked the Chancellor of the Exchequer how much has been paid from the Contingencies Fund so far in the current year for purposes connected with the Falkland Islands.

The Chief Secretary to the Treasury (Mr. Peter Rees): Nothing.

Mr. Dalyell: Is Falklands expenditure one of the reasons why the offsetting item of "general allowance shortfall" should have been nil in 1981–82, but increased to £950 million in 1982–83 and is £1,200 million for 1983–84? What other explanation is there?

Mr. Rees: Precise provision for expenditure in the Falklands has been made. That can be judged from the most recent public expenditure White Paper.

Local Authorities (Loans)

Mr. Richard Wainwright: asked the Chancellor of the Exchequer if he will make a statement on the implications for the public sector borrowing requirement and the central Government borrowing requirement of continuing his preferential loans policy for local authorities via the national loans fund.

Mr. Peter Rees: Our policy of encouraging local authorities to borrow from the Public Works Loan Board raises the central Government borrowing requirement, but has no effect on the public sector borrowing requirement.

Mr. Wainwright: Although the present pattern of interest rates encourages local government to go to the Public Works Loan Board voluntarily, that will not always be so. Can the Chief Secretary assure the House that he does not intend to ask for powers to compel local government to bypass the market and use the Public Works Loan Board?

Mr. Rees: I am happy to give the hon. Gentleman that assurance.

Sir William Clark: To what extent has borrowing by local authorities been reduced because of the sale of council houses?

Mr. Rees: I cannot say precisely how much, but such sales have represented a useful contribution to local authorities finance. About £1 billion has been gained in the past year.

Mr. Skinner: Will the Chief Secretary confirm that local authority borrowing has increased mainly because they have to pay ten times as much as they receive from the sale of a house to build a new one? Is he aware that in many constituencies mortgage arrears now exceed rent arrears in the housing revenue account?

Mr. Rees: Local authority expenditure has not increased for that reason.

Free Ports

Mr. Foulkes: asked the Chancellor of the Exchequer if he will make a statement on the current position, in relation to his Department's responsibility, on the proposed establishment of free ports.

The Minister of State, Treasury (Mr. Barney Hayhoe): Potential operators have been invited to submit applications for free port status by 31 October. Final decision on the locations will then be taken by my right hon. Friend the Chancellor in consultation with other ministerial colleagues.

Mr. Foulkes: Is this not yet another example of the Government being left at the starting post because of indecision? Is the Minister aware that even the Isle of Man is about to announce the establishment of a free port, the duration of which is not affected by legislation? In the light of that, will the Government review the five-year experimental period which they are imposing on free ports as it is causing great uncertainty and indecision among many potential operators?

Mr. Hayhoe: I welcome the hon. Gentleman's support for free port policy.

Mr. Foulkes: I did not say that.

Mr. Hayhoe: There is an agreement between the Isle of Man authorities and the United Kingdom which requires a common approach to Customs procedures. The Isle of Man's free port development will be operated under existing Customs duty relief arrangements, which are freely available elsewhere in the United Kingdom.

Mr. Hill: Is my hon. Friend aware that there are about 400 free ports in the world and that the number of experimental free ports here—between four and six—will be utterly inadequate? Does he agree that the Government could well decide to have at least 12 in the experiment?

Mr. Hayhoe: We have made no announcement about the precise number of free ports. So far we have received only three applications. The closing date is Monday. I confidently expect many more applications to be handed in by then.

Rev. Martin Smyth: May I assume that when the Chancellor discusses these matters with his colleagues he will include the Secretary of State for Northern Ireland and that his views will also be considered?

Mr. Hayhoe: Without any doubt, I can give that assurance.

Balance of Payments

Mr. Maxton: asked the Chancellor of the Exchequer what is his latest estimate of the current account of the balance of payments for 1983.

Mr. Terry Lewis: asked the Chancellor of the Exchequer whether the forecast contained in the Budget Statement and Financial Review 1983–84 of a surplus on current account balance of payments of £1½ billion remains his best estimate of the likely outturn of this item.

The Financial Secretary to the Treasury (Mr. John Moore): A new forecast will be given in my right hon. Friend's autumn statement.

Mr. Maxton: Is it not a disgrace that Britain's manufacturing trade is running at a deficit of £4 billion? Does the Minister agree that that is the worst trading figure since Tudor times? Is that not a sign of how badly the Government are running the economy? Is it not time that they made way for a Government who could do better?

Mr. Moore: It is extraordinarly difficult to expect a word of congratulation for Britain's workers on the recently announced September surplus of £270 million. I should have thought that hon. Members on both sides of the House would welcome that. Opposition Members might find it helpful to know that, although manufacturing is an important part of our economy, it employs only 27 per cent. of the nation's work force.

Mr. Terry Lewis: How many jobs in manufacturing industry have been lost because of the £4 billion deficit?

Mr. Moore: The House will be much more interested to learn that, in a changing and competitive economy, the percentage of Britain's working population employed in manufacturing industry is similar to that in West Germany and France. It is difficult to understand the statements of the new Leader of the Opposition when he argues that unproductive labour includes those employed in financial activities, insurance, banking and business services, as those concerns employ 1·3 million British people in extremely productive work.

Mr. Eggar: If we are to continue exporting successfully, as we have been doing in the past four years, is it not vital that we keep control over wage increases?

Mr. Moore: My hon. Friend is quite right. Wage increases are one of the factors involved in maintaining cost competitiveness, which is essential if we are to hold our markets. To that extent I endorse what my hon. Friend says.

Mr. Forman: As the balance of payments is substantially affected by import penetration—which must be a source of anxiety to the Treasury—is my hon. Friend, whom I welcome to his new responsibilities, keen on encouraging infrastructure or capital investment, which usually has a low import content and therefore does not cause difficulty with the balance of payments?

Mr. Moore: I am tempted simply to say yes, but the essence of the latter part of my hon. Friend's statement is correct. The key to it is profitability in an industry, which will attract investment to that industry, which in turn, added to effective cost competition in labour expenses, will enable us to win back world markets.

Mr. Wrigglesworth: Is it not a fact that the balance of payments has been shored up by oil exports? Will not

those oil exports decline steadily during the coming years, and what plans do the Government have to shore up what will then be a catastrophic state of affairs?

Mr. Moore: It is always interesting to find ways in which the new party seems not to wish to embrace economic market freedom. I cannot understand why its Members assume that the 100,000-odd jobs that have been created by an investment of £35 billion from the private sector into such a successful industry should be ignored. It is also difficult to understand how they can ignore the enormous achievement in the creation of a massive overseas asset. We now have net assets overseas worth £42 billion, as opposed to £10 billion in 1978, which are already producing net portfolio remittances of about £ 1·6 billion a year, as opposed to £400 million a year in 1978.

Mr. Shore: I, too, congratulate the Minister on his promotion within the Treasury, and I wish him good fortune, especially in solving the growing new problem of balance of payments deficits. Surely the Minister understands and recognises that, of all the figures that have been exchanged across the Floor of the House during this Question Time and many previous ones, nothing is more grievously damaging to the fortunes and prospects of Britain than the massive deterioration in the balance of payments that has taken place this year. Does he agree that within the past 12 months our balance of payments has deteriorated by no less than £5,000 million and that we are heading for the most serious crisis in our balance of payments in the year ahead? What will he do to restore the competitiveness of British industry so that we can resist import penetration and promote our exports? How will he handle the continuing problem of a massive outflow of capital from Britain?

Mr. Moore: I thank the right hon. Gentleman for his kind words. It might be useful to correct the misapprehension that the outside world might have. We are not in balance of payments deficit. The figures for the first nine months of this year show an approximate surplus of more than £550 million. I recognise that manufacturing figures are down, but one of the happy factors in the longterm development of Britain is that our economic development is ahead of that of most of our European competitors.

Stamp Duty

Mr. Heddle: asked the Chancellor of the Exchequer what is his latest estimate of the yield to the Exchequer from stamp duty on the disposal of freehold and leasehold property.

Mr. Hayhoe: The Budget estimate for 1983–84 was £510 million.

Mr. Heddle: Is not my hon. Friend undertaking a review of stamp duty, and is not a consultative document out at present? Does he agree that if new house transactions were relieved of stamp duty this would stimulate the construction industry and help first-time buyers?

Mr. Hayhoe: My hon. Friend is right to say that the consultation document has been published, and 70 replies were received by the date on which we asked for reply, which was 30 September. The replies are now being considered carefully. It is difficult to justify the exemption


of one type of property, such as new houses, and it is equally difficult to exempt first-time buyers. However, 80 per cent. of first-time buyers do not pay stamp duty.

Mr. Kirkwood: Does the Minister agree that the threshold at which stamp duty is set is so high that it is beginning to restrict social mobility around the country? Is it not unfair that the Government should index-link the thresholds for capital transfer tax and capital gains tax, but not do so for stamp duty?

Mr. Hayhoe: The threshold for stamp duty on property has been raised twice since the 1979 election, but it is lower than what would have been required to keep pace with prices. That is not a major or significant impediment to social mobility.

Mr. Alexander: Does my hon. Friend agree that a penalty of 2 per cent. on a purchase price of more than £40,000 is a significant disincentive to a prospective purchaser? To encourage home ownership and mobility of labour, will he consider the possibility of imposing stamp duty on the excess over thresholds of £30,000, £35,000 and £40,000, rather than on the entire purchase price?

Mr. Hayhoe: The slice approach, about which my hon. Friend talks, was one point that emerged as a result of the consultation document. It has many supporters, as opposed to the band principle. I suspect that most people wish to see a reduction in the stamp duty yield, as we all do, but one must take account of the significant revenue that it brings in. I know that my right hon. Friend the Chancellor will be considering all those matters in his next Budget.

Public Expenditure

Mr. Sedgemore: asked the Chancellor of the Exchequer whether he intends to make any further reductions in the level of public expenditure.

Mr. Ioan Evans: asked the Chancellor of the Exchequer if he has any plans for future changes in public expenditure.

Mr. Peter Rees: The 1983 public expenditure survey is still in progress. For 1984–85 and 1985–86 our objective is to hold to the totals of expenditure published in the last public expenditure White Paper. For 1986–87 we aim to keep total expenditure at broadly the same level in real terms.

Mr. Sedgemore: When next revising his public expenditure figures, will the Chief Secretary ask the Chancellor whether, for the moment, he will give up his determination to become the sarcophagus of 18th century British liberal economics, whose theories have been discarded by all rational people and rational Governments? In assessing the problems of 20th century depression, will he tell both the House and the 150 four-year-olds who have come here from Hackney today whether in his view, in theory or in practice, a relaxation of fiscal policy, including an increase in public expenditure, can lead to a permanent increase in the effective level of demand? If not—[Interruption.]

Mr. Speaker: Order. I think that is enough. It is unfair to other hon. Members to ask four or five questions at once.

Mr. Sedgemore: rose——

Mr. Speaker: Order. I think that is enough.

Mr. Rees: The hon. Gentleman's political and economic theories may still be stuck in the 18th century, but those of the Government whom I am proud to represent are not.

Mr. Skinner: Answer. Say yes or no.

Mr. Rees: I was asked about seven questions, and I am trying, in the interests of the House, to find a relevant question to answer. The hon. Gentleman must await the outcome of the present public expenditure round and the autumn statement.

Mr. Evans: As the European Assembly voted today not to pay the agreed rebate to Britain, what effect will that have on future public expenditure? As the cuts in regional aid have led to massive unemployment, is it not being penny wise and pound foolish to stop capital investment in productive industry?

Mr. Rees: I am unaware of any measures that have led to a cut in investment in industry. The hon. Gentleman may be aware of the generous system of capital allowances perpetuated by this Administration. It is a little early to say how the European matters which the hon. Gentleman mentioned will work out. The issue must go back to the Council of Ministers.

Mr. Kenneth Carlisle: Does my right hon. and learned Friend agree that the grim reality is that there is remorseless pressure for spending to increase in every area of Government? Does he accept that, by and large, the general public do not appreciate that and do not realise the terrible consequences for tax which it implies? Is it not time to open up the debate on how we finance the huge Departments of State in the long term?

Mr. Rees: I am grateful to my hon. Friend for drawing attention to the problems, and he is not the first of my hon. Friends to do so. This should be a matter of public concern, and it would be extremely helpful if there were an informed debate about the real options facing Britain, rather than the spurious options peddled by the Opposition.

Mr. Renton: Does my right hon. and learned Friend recall a report in The Times a few weeks ago that the Chancellor intended to open up the public expenditure debate and involve a rather wider public? That is an excellent idea. Was that report correct and, if so, how does my right hon. and learned Friend intend to implement it?

Mr. Rees: If my hon. Friend was at Blackpool, he will recall that at least three speeches from the platform dealt with this question. I am sure that future contributions from my right hon. and hon. Friends will be welcome.

Mr. Shore: The Chief Secretary referred to informed debate about the real options facing the country. Was not the failure of the Treasury and the Government to provide the nation with the real information and real choices ahead the most disgraceful part of their behaviour during the general election? We understand that we must await the full autumn forecast, but why has the Chief Secretary already decided to cut the rate support grant, NHS expenditure and repair grants to the already terribly damaged building industry? If what the Chancellor said about a sustained recovery of the economy is true, why have these cuts been pressed forward with such vigour?

Mr. Rees: I cannot identify the cuts to which the right hon. Gentleman refers. If he will contain his impatience, he may be enlightened during tonight's debate on what has happened in the NHS. He will perhaps then appreciate the massive resources that have been committed by the Conservative Government since 1979, which reflects great credit on this Government. That point appears to have escaped the right hon. Gentleman's attention.

International Competitiveness

Mr. Canavan: asked the Chancellor of the Exchequer what has been the change in international competitiveness of British industry since May 1979.

Mr. Moore: There is no unique measure of international competitiveness, and no way of measuring important non-price factors, but since May 1979 the United Kingdom has sold nearly £22 billion more goods and services overseas than we have imported.

Mr. Canavan: Now that the Tories have made British industry 15 per cent. less competitive than in 1979, when we have a Prime Minister who yearns for Victorian times, when industrial production is about the lowest since the industrial revolution and our trade in goods is in deficit for the first time since the 16th century, how much further back will the clock be turned because the Department of Trade and Industry has recently suffered from a Norman invasion?

Mr. Moore: I remind the hon. Gentleman, who comes from a Scottish constituency, of the relevance of oil to the Scottish and United Kingdom economies—a key factor in the creation of new jobs. We all recognise the difficulties faced by manufacturing in a world recession, but I hope the hon. Gentleman will recognise that the economy includes other areas, such as oil.

Mr. Rathbone: What benefit or influence will the introduction of free ports have on international competitiveness? If it is on the plus side, will my hon. Friend press his colleagues in the Treasury to increase the number of free ports that will be authorised this week?

Mr. Moore: I congratulate my hon. Friend on his ingenuity in attaching this matter to question No. 8. I am sure that my hon. Friends will recognise the way in which he has put his constituency point across.

Mr. Straw: Is the Financial Secretary aware that his answer to my hon. Friend the Member for Falkirk, West (Mr. Canavan) was outrageously evasive? Has the Treasury Bench now decided to give only statistical answers where it thinks such statistics help it? Is it not the case that over the past four years we have lost 15 per cent. on competitiveness through measures that the Government previously accepted? Has not the CBI claimed that we are now 30 per cent. less competitive than we were in 1975 and that most of the loss has occurred since 1979? Does not this massive loss of competitiveness confound the Minister's ludicrous claims that Britain is the country in Europe that is now making a major recovery? No country in Europe has suffered a worse recession than the United Kingdom or has further to go to return to its competitive position in 1979. Will the Financial Secretary——

Mr. Speaker: Order. The House will accept that the same rules must apply to Front Benchers as apply to Back Benchers.

Mr. Moore: I thought that certain elections did not take place until later today. Perhaps I can reply to part of the hon. Gentleman's question. Rather than swapping detailed statistics, it might be more relevant to look at the specifics of some aspects of our trade. For example, over the past four years our trade with France has increased in gross value by more than 50 per cent. while the exchange rate has appreciated against the French franc by 31 per cent. When one talks about trade, one does not merely talk of oil. We can continue to swap data across the floor. The hon. Gentleman referred to the IMF series data. I remind him that compared with the first quarter of 1981 our relative actual unit labour costs have been reduced by 21 per cent.

Women (Taxation)

Ms. Harman: asked the Chancellor of the Exchequer what proposals he is considering to end discrimination within the tax system against women.

Mr. Hayhoe: This is one of the many issues discussed in the Green Paper on the taxation of husband and wife. The Government are considering these issues in the light of the wide-ranging views expressed in response to the Green Paper.

Ms. Harman: Is it not unfair that, even when a married man and married woman earn the same, the married woman takes home less in her pay packet because she is paying more in tax? Is it not about time that the Government accepted the representations of the Conservative women's organisations, the Equal Opportunities Commission and the TUC to the effect that a much better way of arranging things would be to abolish the married man's tax allowance and instead subsidise families through child benefit.

Mr. Hayhoe: As the hon. Lady knows, it is possible for a husband and wife to elect to be taxed separately, in which case the situation to which she referred would not arise. As I have said, the issues involved are deep and complex. If the married man's allowance were removed, it would considerably reduce the threshold for income tax and increase the problems of the poverty and employment traps. Therefore, there are deep problems and no simple solutions to them.

Mr. Maxwell-Hyslop: Has my hon. Friend noted that, even if a husband and wife are taxed separately, if the nature of their occupations necessitates them living in different locations, when they retire and have to sell those locations one or other must pay capital gains tax, which they would not do if they were not married?

Mr. Hayhoe: The taxation system contains many anomalies with regard to the taxation of men and women. That is not in dispute, but it is difficult to find a widely acceptable way of resolving those differences.

Mr. Douglas: It is difficult for me to raise this matter, but will the Minister acknowledge that the tax affairs of Lady Carnegy—who has declared her unwillingness to continue in office as chairman of the MSC in Scotland as a result of disclosures relating to the Inland Revenue in Scotland and elsewhere—are extremely disquieting? Will he explain the way and method by which these disclosures came into the public domain——

Mr. Speaker: Order. It is difficult to relate the hon. Gentleman's supplementary question to the question asked by the hon. Member for Peckham (Ms. Harman).

Mr. Douglas: With respect, Mr. Speaker, my hon. Friend's question relates to the tax affairs of women. It is important that the Minister should explain how these affairs, which are "confidential", have come into the public domain, to the gross embarrassment of the Tory party.

Mr. Hayhoe: One thing is perfectly clear—it is wholly outside the traditions and practice of this House for the tax affairs of an individual to be raised in this way at Question Time.

Mr. Nicholls: Is there not a worse form of discrimination against married couples in that an unmarried couple living together can so arrange their affairs that if they accept responsibility for one child each they get both lots of single person's allowance and additional personal allowance as well? Is it not wholly wrong that those living outside wedlock have a better deal in that regard than those living inside wedlock?

Mr. Hayhoe: My hon. Friend draws attention to one of the difficulties of the present system. As I have said, it is easy to draw attention to the difficulties, but the problem is to find a widely acceptable solution to them.

Interest Rates

Dr. McDonald: asked the Chancellor of the Exchequer if he will make a statement on the present level of interest rates.

Mr. Lawson: The recent reduction in the clearing banks' base rates to 9 per cent. means that they have fallen 7 points from their last major peak in October 1981, and are now back to their lowest level of the last five and a half years.

Dr. McDonald: Nevertheless, real interest rates are still quite high. Is there not scope for reducing interest rates further to enable industry, and in particular industry conducted by small and medium-sized businesses, to invest and expand further?

Mr. Lawson: I agree with the hon. Lady about the desirability of lower interest rates, and the Government's medium-term financial strategy, based on a steady decline in the growth of the money supply and in the PSBR as a proportion of GDP, is designed, inter alia, to achieve that end, and 'that is what has been happening.

Mr. Latham: Are not mortgage interest rates at least 1 per cent. too high, and should they not come down next week, and not next month?

Mr. Lawson: I read in the papers that there was a possibility that the building societies would decide to reduce their mortgage rates and if that is so, I am sure that the House will welcome it. It is interesting to note that, even at the present level, mortgage rates are lower than they were when this Government first took office.

Mr. Robin Cook: Did the Chancellor notice yesterday's statement by the United States' Treasury Secretary that although we shall hear much about the connection between Government deficits and interest rates, we shall see no hard data? In view of the

Government's anxiety not to disagree with the United States Administration, will the Chancellor take this opportunity of agreeing with the American Treasury Secretary that there is no discernible connection between Government deficits and interest rates and all that the House has heard on this matter in the past four years has been so much monetarist mumbo-jumbo?

Mr. Lawson: I agree with Paul Volcker, the chairman of the Federal Reserve Bank, and with Mr. Martin Feldstein, the chairman of the Council of Economic Advisers in the United States, that there is a clear and direct connection between the size of the budget deficit and the level of interest rates.

Direct Taxation

Mr. Andrew MacKay: asked the Chancellor of the Exchequer if he will consider reducing the level of direct taxation in the United Kingdom.

Mr. Lawson: Yes, Sir, but not at the expense of letting Government borrowing rip, with all that that would mean for interest rates and inflation.

Mr. MacKay: Does my right hon. Friend agree that, on the day that the House is debating the degree of increase in expenditure in the Health Service, it would be right to reflect that a large number of people voted for our Government back in June because they hoped that they would be cost-effective in the public sector and that this would lead to cuts in direct taxation, which would give an incentive to those who create wealth and prosperity?

Mr. Lawson: My hon. Friend is right and I am sure that later today he will hear my right hon. Friend the Secretary of State for Social Services point out how he is trying to get a more cost-effective Health Service.

Mr. Skinner: Is the Chancellor aware that he would be able to bring direct taxation down more easily if he were to bring in some controls on the £4,000 million lost through tax avoidance and tax evasion, exemplified in an article this week, which showed that the Duke of Devonshire has now set up a trust and does not pay any tax and has thus joined the ranks of Lord Vestey and his group who somehow do not seem to pay any taxes?

Mr. Lawson: It has now become almost part of our constitution that the hon. Gentleman should bring out the Duke of Devonshire each Question Time, whatever the subject under discusssion.

Mr. John Townend: Does my right hon. Friend agree that at least a portion of savings from privatisation should go back to the Treasury to pay for reduced taxation?

Mr. Lawson: Although the purpose of privatisation is to have a more effective, more efficient, more competitive and more dynamic economy, there are benefits to the Treasury along the road.

Retail Prices Index

Mr. Tim Smith: asked the Chancellor of the Exchequer what is the latest annual increase in the retail prices index.

Mr. Lawson: Over the 12 months to September 1983, the retail prices index increased by 5·1 per cent.

Mr. Smith: Does my right hon. Friend recall that during the election campaign the right hon. Member for


Birmingham, Sparkbrook (Mr. Hattersley) said that by May 1984 inflation would be in double figures? Is it not the case that by this time next year inflation will be at its present level or lower?

Mr. Lawson: I am looking forward to the middle of next year, not least because that will show how completely without foundation was the estimate made by the right hon. Member for Birmingham, Sparkbrook (Mr. Hattersley). The Treasury will be making a forecast for inflation in the normal way at the time of the autumn statement. All the indicators are that the path of inflation through 1984 is likely to be down.

Oral Answers to Questions — PRIME MINISTER

Engagements

Mr. Stan Thorne: asked the Prime Minister if she will list her official engagements for Thursday 27 October.

The Prime Minister (Mrs. Margaret Thatcher): This morning I presided at a meeting of the Cabinet and had meetings with ministerial colleagues and others. In addition to my duties in the House I shall be having further meetings later today.

Mr. Thorne: Can the Prime Minister confirm that it is true that the Governor-General of Grenada, Sir Paul Scoon, approached the Eastern Caribbean States for military assistance, as has been reported to the United Nations by the Prime Minister of Dominica, and if it is true, say who authorised Sir Paul to do that?

The Prime Minister: No request for intervention from the Governor-General was passed through British channels, nor was any such request reported to us.

Mr. Temple-Morris: Does my right hon. Friend recall that only yesterday the right hon. Member for Leeds, East (Mr. Healey) referred to Grenada as British territory, when he talked of a threat to British territory? Will my right hon. Friend make it clear that Grenada is not British territory, but rather is an independent Commonwealth state?

The Prime Minister: I confirm what my hon. Friend says. Grenada is an independent sovereign state, and is not British territory. [HON. MEMBERS: "Or American."] The Governor-General is not British but was appointed on the recommendation of the first Prime Minister of the independent Grenada.

Dr. Owen: Is the Prime Minister aware that it has now become public knowledge that the mobile land forces were placed on standby for several days? How long has that been the case, and were they told to go on alert to go to Grenada yesterday? Will the Prime Minister assure the House that there is no question of British troops being used other than as part of a Commonwealth peacekeeping initiative? Does this now mean that the Government are accepting their responsibility and taking a joint role, together with the Commonwealth, on Grenada?

The Prime Minister: As both my right hon. and learned Friend and I have said, no British troops were involved in the landing on Grenada. HMS Antrim is there and was instructed to go there on Sunday as a precautionary measure, to take off British citizens should they be in danger. There has been no change in the

position. We are grateful to the United States, which is looking after British citizens and evacuating them from Grenada.

Mr. Kinnock: Following that answer, could the right hon. Lady tell us what obligations she now feels towards the President of the United States?

The Prime Minister: I feel the obligations of a very close ally. I also feel the obligations of one member of NATO to the United States, without whose support, freedom and justice in Europe would be in doubt.

Mr. Kinnock: Is it not a fact, however, that the special relationship between Britain and the United States is now somewhat in question, and that the only reason for that is that the relationship that was said to exist between the right hon. Lady and the President turned out to be not so special? In the chaos and humiliation of the Grenada affair, will the right hon. Lady at least take the opportunity of adopting a new deportment in world affairs and, as a consequence, demonstrate a greater independence in furthering British interests and working for peace throughout the world?

The Prime Minister: When two nations are friends each owes the other its own judgment. That does not mean that the other in either case is compelled to accept it. It would hardly be a friendship unless one could tender advice to another country——

Mr. Foulkes: And have it ignored.

The Prime Minister: —and have it either accepted or rejected. We do not run the sort of Warsaw pact organisation that the right hon. Gentleman—[Interruption.]

Mr. Kinnock: I would be the last to suggest the rendering of any alliances, but when the judgment of this Government is apparently utterly cast aside and trampled on by our ally, what obligation does the right hon. Lady then have?

The Prime Minister: It follows from what the right hon. Gentleman has said that, as the United States and Britain are allies, we would always have had to accept any advice that the United States gave us. Indeed, it follows that we would not be free to accept or reject the advice of the United States. However, at the beginning of the Falklands affair we did not ask the United States whether we should recapture the Falklands. We took our own decisions. When the United States took the part of an independent negotiator at the beginning, it was we who in the end persuaded the United States to follow us.

Mr. Dubs: asked the Prime Minister if she will list her official engagements for 27 October.

The Prime Minister: I refer the hon. Gentleman to the reply that I gave some time ago.

Mr. Dubs: Is the Prime Minister aware that all hon. Members understand why she was so obviously angry with the Foreign Secretary at the end of yesterday's debate? Will she now dissociate herself and her Government from what the right hon. and learned Gentleman said on "Newsnight" last night, when he announced that it would be a matter for rejoicing if the invasion of Grenada resulted in a Government more to his liking?

The Prime Minister: I fully agree with everything that the Foreign Secretary said yesterday, particularly his view


that there are much larger issues at stake between the United States and the United Kingdom, such as the whole future of the freedom of Europe and the whole future of NATO. We stand by the United States and will continue to do so in the larger alliances. The United States is the final guarantor of freedom in Europe—[Interruption.] and I hope that that will not be undermined by anything said by the Opposition. It—[Interruption.]

Mr. Speaker: Order. I cannot hear what the Prime Minister is saying because of the noise.

The Prime Minister: I think that the latter part of the question asked by the hon. Member for Battersea (Mr. Dubs) concerned the restoration of democracy in Grenada. I should be very glad if democracy was restored in Grenada and operated there. The United States, in very similar circumstances in 1965, went into the Dominican Republic and then pulled out, and democracy was restored there, and still persists today.

Mr. Tapsell: Has not the time now come to put our full support behind our ally, the United States, in the United Nations and elsewhere and to take a lead in setting up a Commonwealth force to replace the American presence in Grenada?

The Prime Minister: I think that the Secretary-General of the Commonwealth has said that he is ready to use his good offices. If he were to make a request we would, of course, consider it. As my hon. Friend has said, the matter is being discussed in the United Nations, and it is our intention to abstain on that resolution.

Hon. Members: Shame.

Mr. Rowlands: Will the Prime Minister take time this afternoon to ring President Reagan and tell him plainly that we will not support in any shape or form the cynical manipulation of the Queen's representative, the Governor-General, in bringing into Grenada some pre-packaged Government from outside?

The Prime Minister: No, Sir. The position of them? Governor-General is perfectly clear constitutionally. He is not in any way responsible to the Government of the United Kingdom, nor does he in any way take instructions from the Government of the United Kingdom.

Mr. Eldon Griffiths: What exactly are the orders now to HMS Antrim? Is it supposed to be helping the Americans, on the ground that the Americans have rescued our people and have the Governor-General in their care, or is it supposed to be hindering the Americans on the ground that Her Majesty's Government disapprove of their action? It is vital to tell the House what the orders for HMS Antrim are.

The Prime Minister: The orders are much simpler than my hon. Friend perceives. They are for the protection and evacuation of our own people.

Mr. Ron Davies: asked the Prime Minister if she will list her official engagements for Thursday 27 October.

The Prime Minister: I refer the hon. Gentleman to the reply that I gave some moments ago.

Mr. Davies: What positive steps does the Prime Minister now intend to take to restore democracy to Grenada? Would not the first most positive step be to condemn the American presence in Grenada and to call for the immediate withdrawal of all American troops?

The Prime Minister: No, Sir. The Government of the United Kingdom have no residual responsibility for the independent sovereign state of Grenada. As I pointed out earlier, when, in 1965, the United States intervened in the affairs of the Dominican Republic, democracy was restored and the United States pulled out. Democracy has persisted there ever since.

Sir John Biggs-Davison: Since the Governor-General—the representative of the Queen of Grenada—is the last remaining embodiment of constitutional order on the island, would not the position that he took have fully justified any support that we could give to Commonwealth partners who loyally supported us over the Falklands affair? Will my right hon. Friend give due consideration to the proposal made by my hon. Friend the Member for East Lindsey (Mr. Tapsell) regarding a Commonwealth force?

The Prime Minister: There is not very much that I can add to what I have said. The deputy high commissioner from Barbados saw the Governor-General on Sunday in Grenada and was accompanied there by two American consular representatives. The Governor-General did not indicate in any way then to the deputy high commissioner any request for intervention. I can only give my hon. Friend the facts as I know them. That does not mean to say that we are in full possession of the facts. There may have been other requests that were made that I know nothing about. I cannot go any further than what I have said. My view with regard to the Grenadian matter is as I gave it in response to questions the last time that I replied.

Mr. Hoyle: Will the Prime Minister take time today to find out why, although the Governor-General has been in American hands for 24 hours, he has not been in touch with the Palace? Is that why she cannot comment on the statement by the Dominican Prime Minister? What steps have been taken to find out whether the statement is true or false?

The Prime Minister: I have no responsibility to answer for the Governor-General—[HON. MEMBERS: "Oh!"] No responsibility in any way. I have given the facts as I know them. No request was made through Britain, or to the knowledge of Britain. I understand that a statement was issued from the Palace this morning to the effect that it does not know of any such request. That does not mean that such a request was not made; it means that we do not know of one.

Mr. Rippon: While I regret that we did not support our Caribbean Commonwealth partners from the outset, may I ask my right hon. Friend to make it clear that we are willing to contribute to a Commonwealth peacekeeping force if asked to do so?

The Prime Minister: The Government will, of course, sympathetically consider any reasonable request, as my right hon. and learned Friend might expect.

Business of the House

Mr. Neil Kinnock: May I ask the Leader of the House whether he will state the business for next week?

The Lord Privy Seal and Leader of the House of Commons (Mr. John Biffen): The business for next week will be as follows:
MONDAY 31 OCTOBER—A debate on a Government Motion on the NATO 1979 decision on intermediate range nuclear forces.
TUESDAY I NovEmBER—Proceedings on the British Shipbuilders (Borrowing Powers) Bill.
Motion relating to the Education (Fees and Awards) Regulations.
WEDNESDAY 2 NovEMBER—Remaining stages of the Petroleum Royalties (Relief) Bill.
Motions on the Town and Country Planning (Fees for Applications and Deemed Applications) Regulations for England and Wales, and for Scotland, and on the Rate Support Grant (Scotland) Order.
THURSDAY 3 NovEmBER—There will be a debate on foreign affairs on a motion for the Adjournment of the House.
FRIDAY 4 NOVEMBER—A debate on Government measures to assist small businesses, on a motion for the Adjournment of the House.
MONDAY 7 NovEmBER—Second Reading of the Police and Criminal Evidence Bill.

Mr. Kinnock: The Opposition welcome Monday's debate on intermediate range nuclear forces. It will give the House an opportunity to examine in some detail the Government's serious lack of concern about the increasing nuclear arms race. Do not the Government realise that the events of the last few days have greatly increased the anxieties of the British people about lack of proper control over the cruise missiles which, apparently, are to be emplaced in this country?
The Opposition are willing to facilitate Tuesday's proceedings on the British Shipbuilders (Borrowing Powers) Bill, because we recognise that the future of the crucial shipbuilding industry is threatened by Government policies. We shall want a further discussion in the House on the imminent collapse of the industry.
I regret that Thursday's debate on foreign affairs will be on a motion for the Adjournment of the House. That forbids the possibility of our tabling a motion and dividing the House. That might not be unconnected with this week's events. Are the Government aware that we will welcome a wide-ranging debate on their multiple failures in foreign affairs?
Will the Leader of the House have urgent discussions through the usual channels about the setting up of the Select Committees? I shall expedite the appointment of the Opposition Shadow team.
Will the right hon. Gentleman undertake to arrange an early debate, in Government time, on the future of British Rail? The Secretary of State for Transport has taken £200 million from British Rail. We want to be sure that the Government are not introducing the Serpell report by the back door.
Will the Leader of the House arrange an early debate, in Government time, on the serious allegation made this morning by Mr. Harold Evans, the former editor of The

Times, that the Government allowed Mr. Rupert Murdoch to acquire Times Newspapers Limited on the basis of figures about the profitability of The Sunday Times that were intentionally miscalculated?

Mr. Biffen: This is my first opportunity to welcome the right hon. Gentleman to our gentle Thursday exchanges. I know that he comes from south Wales and is, therefore, happily blessed with the inspiration of Aneurin Bevan—a man who loved his country and, above all, the House of Commons as an institution in giving expression to the aspirations of his country. I hope that, with that happy background, we shall find that our proceedings have the correct blend of amicability and acerbity.
I turn immediately to the right hon. Gentleman's sixth point. I gather that I am in some way the central figure in the detestable drama concerning The Times. I cannot offer any guarantee that Government time will he made available for a debate, but I shall consider the right hon. Gentleman's point. I have not seen any of the reports; I have not been blessed with a copy. However, I shall take note of what has been said.
The House has had, an important statement about British Rail, followed by a useful Question Time. I cannot guarantee to make time available for a debate, but I shall understand it if the right hon. Gentleman wishes to proceed with that matter through the usual channels.
The right hon. Gentleman raised the important issue of departmental Select Committees. I share his enthusiasm and anxiety that they should be established as quickly as possible. He offered the facilities of the usual channels to that end. We hope that it will be possible for the Committee of Selection to table the necessary nomination motions next week.
The right hon. Gentleman referred to the fact that the foreign affairs debate will take place on a motion for the Adjournment. I am sure that he will acknowledge that that is frequently the device chosen because it enables a wide-ranging debate to take place. I should be surprised if, during the debate on Thursday, matters affecting the middle east, as well as matters in the Caribbean, were not raised. However, the right hon. Gentleman has asked me to consider his point, and I shall do so.
The great zeal for debating shown by the right hon. Gentleman is consistent—[Interruption.] He is a practitioner of debating. However, I have to balance all the demands on the time of the House. I noted his point about a debate on the shipbuilding industry.
On Monday's debate on intermediate range nuclear forces, I accept that there is now an added topicality which gives it that much more importance.

Mr. Geoffrey Rippon: To ensure that there is time for all the debates, will my right hon. Friend give an undertaking that there will be no debate on the Government's local government proposals until there have been many further discussions with local authority associations and others concerned? Is he aware that, as the proposals stand, they are pretty muddled, likely to be costly and ineffective, generally undesirable and a further reinforcement of what the Lord Chancellor called "elective dictatorship".

Mr. Biffen: I know that, as my right hon. and learned Friend is an heroic realist, he will not expect me to


comment on the merits or otherwise of his observations. There are no immediate plans for legislation on that matter.

Mr. A. J. Beith: Will the Leader of the House arrange for a statement from a Minister at the Department of Employment on what has happened to the equal pay regulations, as we understand, following representations from my noble Friends in another place, that the matter is not being proceeded with?
Will the right hon. Gentleman also arrange for a statement to be made by a fisheries Minister on progress in EC negotiations during the summer? There are great fears in the fishing industry that important fisheries—herrings, sprats and lobsters—will be closed to our fishermen as a result of decisions taken now.

Mr. Biffen: I shall immediately refer the hon. Gentleman's point about fisheries to my right hon. Friend the Minister of Agriculture, Fisheries and Food.
The regulations on equal pay are still before another place. I shall look into the matter and write to the hon. Gentleman.

Mr. Edward du Cann: I welcome my right hon. Friend's announcement that we shall at last make progress with re-establishing the departmentally related Select Committees, but will he be good enough to say clearly that the recommendations of the Chairmen made in the previous Parliament through the Liaison Committee will be accepted for their further improvement?

Mr. Biffen: Clearly that is a material matter with which the Government will be concerned. I undertook to my right hon. Friend the Prime Minister to bring forward two amendments to Standing Orders arising from the Committee's recommendations and I propose to table those shortly.

Mr. Robert N. Wareing: Will the Leader of the House find time to include in the business of the House a discussion of the Government's failure to publish all the Mosley papers so that the British people may know how far there was Fascist penetration of the Conservative party in the years before the war as we know that it exists at the present day?

Mr. Biffen: That is a perfectly legitimate subject to be pursued by an hon. Member using all the facilities in the House that are available to a Member.

Mr. Norman St. John-Stevas: I thank my right hon. Friend for his helpful answer on the setting up of the Select Committees and assure him that we realise that any delay on that is not due to him. Will he be equally forthcoming and expeditious in announcing what Bills he intends to submit to the new public Bill procedure which has proved a helpful adjunct to the procedures of the House?

Mr. Biffen: My right hon. Friend knows full well that that rather bland question conceals a more controversial situation than the innocent observer might have supposed. However, I shall look at that. All I can say is that none of the legislation that has been announced for next week's business could conceivably fall within the requirements of that procedure.

Mr. Robert Kilroy-Silk: My right hon. Friend the Leader of the Opposition mentioned the right hon. Gentleman's central role in the acquisition of Times Newspapers Limited by Rupert Murdoch. May we have a statement soon on the serious allegation that is made by Harold Evans in his book published today that the right hon. Gentleman, when Secretary of State for Trade, deliberately misled the House and juggled the figures of Times Newspapers Limited to convey the impression that The Sunday Times was unprofitable so that he could avoid referring Murdoch's acquisition of those newspapers to the Monopolies and Mergers Commission?

Mr. Biffen: I have made it clear that I have not seen those accusations. Of course, I shall take account of the points raised this afternoon, but I do not think that I can reasonably go beyond that.

Mr. Cranley Onslow: Does my right hon. Friend agree that the importance of Select Committees is to be measured not by the number of hon. Members who are occupied upstairs or elsewhere than at Westminster but by the amount of time that the House is able to give to their deliberations? Will he illustrate the importance that he attaches to that by making sure that any changes that he proposes are put before the House for debate before and not after 10 pm?

Mr. Biffen: I shall bear that point in mind.

Mr. Tom Clarke: In view of the long delay by the Department of Trade and Industry in producing the promised review of the British film industry, can the House look forward to a debate on that matter?

Mr. Biffen: As the hon. Gentleman will have seen, there is no provision for such a debate next week and I should mislead him if I said that this matter had a high priority in the demands on Government time. However, I know that with his vastly growing experience as a politician he will find his own way of ensuring that the matter comes to the Floor of the House.

Mr. Terence Higgins: While welcoming the general enthusiasm for the early establishment of departmental Select Committees so that the procedural reforms of the last Parliament can become effective, may I ask whether we can have an early debate on the proposals of the Select Committee on Procedure (Finance) which proposed additional reforms which are necessary if those are to be completed?

Mr. Biffen: The report is of great significance and I am anxious that we should have a debate in the reasonably near future. Although I cannot give a specific reply to my right hon. Friend, I assure him that I hope that we can proceed in that direction soon.

Mr. David Young: In accepting the fact that the foreign affairs debate must, in essence, be wide ranging, will the right hon. Gentleman take on board the fact that we require specific responses? First, may we have a specific statement from the responsible Minister during Monday's debate of the role that the Government now see for the British peacekeeping force in the Lebanon, given the changing circumstances and statements of our allies? It is not the will of the House that one British life should be sacrificed to Presidential megalomania.
Secondly, if air support is requested from Buccaneers and other aircraft stationed in Cyprus, may we have a


written assurance that that decision will not be left to local commanders as it was at one stage but will be a matter for decision by the Prime Minister?

Mr. Biffen: I am sure that the hon. Gentleman will appreciate that my right hon. and learned Friend the Foreign Secretary is much more competent to answer those points than I. I shall ensure that the Government spokesman in Thursday's debate is appraised of the hon. Gentleman' s points.

Mr. Michael Latham: Will my right hon. Friend give an assurance that the motion to be tabled by the Government in Monday's debate will be a clear and detailed statement of support for NATO's two-track policy which can be voted on by the House and thus be the decision of the British Parliament?

Mr. Biffen: My hon. Friend will not be disappointed.

Mr. Eddie Loyden: May I draw the attention of the Leader of the House to early day motion 193?
[That this House congratulates the Labour controlled Liverpool City Council in taking the initiative to create 1,000 jobs and to carry out a public sector housing renewal programme to alleviate the twin problems of mass unemployment and the serious shortage of public sector housing for rent; condemns the Government cuts in the rate support grant which has created major problems for cities such as Liverpool and other cities throughout the United Kingdom; further condemns the inaction of the Government to deal with the unending number of closures and redundancies on Merseyside and, in particular, the recent decisions affecting United Biscuits, Cadbury Schweppes, Central Oils, Huntley &amp; Palmers and major High Street stores, such as Woolworths &amp; Binns with a threatened loss of 7,000 to 8,000 jobs; and supports the decision taken by the Liverpool Labour controlled district council and supported by the Liverpool Trades Council, the Merseyside Association of Trades Councils, and the Liverpool District Labour Party to organise a lobby and demonstration on 19th November against mass unemployment, attacks upon the Health Service, the abolition of the metropolitan counties and the savage cuts in the living standards of working people.]
In view of the closures and redundancies on Merseyside will he give some time for a debate in the House on the questions and problems facing Merseyside?

Mr. Biffen: I am afraid that I cannot give the undertaking in the form that the hon. Gentleman would like, but I suggest that Friday's debate will have as much scope for the consideration of unemployment as for other aspects of business.

Mr. Teddy Taylor: Will my right hon. Friend promise us an early statement on the shameful decision of the European Assembly this morning to block indefinitely the payment of a rebate of £450 million which was promised to Britain? Will he also assure hon. Members that early next week he will arrange for the Minister of Agriculture, Fisheries and Food to give an explanation to the House of what he considers will be the implications to the milk industry and doorstep deliveries of the remarkable regulations published yesterday to allow the import of UHT and sterilised milk from the Continent and the Republic of Ireland?

Mr. Biffen: I shall draw my hon. Friend's point about UHT milk to the attention of my right hon. Friend the Minister of Agriculture, Fisheries and Food. My hon. Friend may have heard my right hon. Friend the Chief Secretary deal with his first point at Treasury questions in a way which I found comprehensive and convincing, but I shall draw my hon. Friend's anxiety to my right hon. Friend.

Mr. Stan Thorne: In view of the need for an early debate on British Aerospace, particularly on the A320 and its development, will the Leader of the House say when the Government propose that that should take place?

Mr. Biffen: No, I am sorry I cannot, but the hon. Gentleman's point will be one of the many factors borne in mind in allocating Government time.

Mr. Eldon Griffiths: Will my right hon. Friend confirm that during the business which he announced for Monday week, the Second Reading of the Police and Criminal Evidence Bill, it will, as far as it lies within his judgment, be in order to debate matters arising from the accompanying White Paper on complaints and discipline?
On Monday's debate on the nuclear dispositions, will my right hon. Friend discuss through the usual channels the possibility of extending the debate for one hour because of the very large number of hon. Members who will wish to take part?

Mr. Biffen: I think that my hon. Friend appreciates that his first point is a matter more for whoever is in the Chair than for me, but I am sure that it will be subject to the conventional wisdom and generosity of the Chair.
I note what my hon. Friend said in his second point. and I shall give consideration to it.

Mr. Dick Douglas: Will the Leader of the House give some indication in the foreign affairs debate of the Government's posture on the law of the sea convention? Our posture seems to be in line with that of the United States and out of line with the rest of the world. May we have some idea about what the United Kingdom Government intend to do about signing this important convention?

Mr. Biffen: If the hon. Gentleman is fortunate in securing Mr. Speaker's eye, I am certain that he will be able to make his argument and that it will be dealt with. Should he not have that good fortune, I shall try to ensure that he receives an answer in some other way.

Several Hon. Members: rose——

Mr. Speaker: Order. I propose to call the hon. Members who are now standing.

Mr. W. Benyon: Now that the appointment of the Select Committees appears to be on the move, will my right hon. Friend give consideration to the early appointment of the Committee on Procedure?

Mr. Biffen: I have made my sympathies known. should like some of the conventional consultations to take place before this matter is concluded.

Mr. David Winnick: In view of the anxiety which has been expressed, may we have a statement next week about the way in which the Minister. of State, Department of Employment, is being subsidised


out of public funds to carry out his duties as Tory party chairman? Is the Leader of the House aware that this is undoubtedly an abuse of public money and public office?

Mr. Biffen: I am sure that the hon. Gentleman wishes to be a fair controversialist, and, therefore, that he would like to take account of the fact that since my hon. Friend has been appointed Minister of State he has taken on the task of deputy in discussions on the Trade Union (Amendment) Bill and has taken over responsibility for international matters and financial and staff management, in addition to his other duties.

Mr. Andrew MacKay: Has my right hon. Friend yet had time to note that yesterday afternoon concern was expressed by Conservative Members about the draft circular on the green belt issued by the Secretary of State for the Environment? Is he aware that this is only the tip of the planning iceberg and that people in Berkshire and, indeed, the whole of the south-east are worried about the proposed structure plan? May we have a debate on planning in the foreseeable future so that this matter can be discussed and many people's fears allayed?

Mr. Biffen: I should like to consider that matter, because I do not doubt the concern that it has evinced in certain parts of the country. I know that my hon. Friend understands that I cannot give the undertaking in the specific terms that he requested.

Mr. Harry Cohen: Has the Leader of the House seen early day motion 177?
[That this House condemns the threat of deportation to Afia Be gum and her two-year-old daughter, Asma, who were first refused leave to enter Britain on 5th June 1982 on the grounds that Afia's husband's death in a fire in Brick Lane invalidated her entry permit; demands that the Home Office threat be lifted immediately and that she be allowed to stay; and views the sentence imposed by Horseferry Road Magistrates' Court on the five Asian women of the Sari Squad who were campaigning on behalf of Afia, who were bound-over for £1,000 each, as an extreme and unjustified sentence.]
Will he find time for a debate on the motion or, at least, have a word with the Minister at the Home Office and ask him to allow this unfortunate woman to stay and build a life for herself in this country?

Mr. Biffen: I cannot refuse the invitation that I should have a word with my right hon. and learned Friend the Home Secretary, and I undertake to do so. However, I would not wish to raise anyone's expectations by that gesture.

Mr. Albert McQuarrie: Will my right hon. Friend consider arranging a debate on the

dependent territory of Gibraltar in view of the economic conditions, the continued closure of the border and the non-implementation of the agreement which was signed on 10 April 1980?

Mr. Biffen: In this sad and sorrowing world, the best chance that my hon. Friend has is the foreign affairs debate on Thursday.

Mr. Ioan Evans: In view of the invasion of the Falkland Islands and Grenada, may we have a statement next week about communications with the Foreign Office in view of the news item that telex messages being sent to London from Grenada went to a Swedish plastic manufacturer and that we received a message from the Grenadian Government on the morning of the American invasion which the Foreign Office said should be put in the post?

Mr. Biffen: I shall ask my right hon. and learned Friend to make a proper evaluation of all these factors and decide whether a statement is necessary.

Mr. Andrew Faulds: Will the right hon. Gentleman arrange a debate in the near future specifically on the implications for the arts of the projected metropolitan county changes, because it is clear that if those changes are carried through the life and work of the arts throughout the country will be gravely hampered if not positively damaged?

Mr. Biffen: I am afraid that I cannot offer Government time for the debate that the hon. Gentleman suggests.

Mr. Faulds: The Government are doing the damage.

Mr. Biffen: Now that the hon. Gentleman wishes to crusade for the arts from the Back Benches, I hope that he will be able to take advantage of all the facilities that are available to a Back Bencher.

Mr. Dennis Skinner: Will the Leader of the House resist any request for a statement on who should attend the Cenotaph service? Has he heard, for instance, that the leader of the Social Democrats has been complaining about wanting to go there on the appropriate day? Will he remind him that the former leader of the Social Democratic party, who is not with us this afternoon, received a request many years ago from the leader of the Scottish National party, which then had 11 Members of Parliament, and he turned it down? Is it not time that the leader of the Social Democrats, who have only six Members of Parliament, did some homework before he went on with his whining?

Mr. Biffen: Notwithstanding what the hon. Gentleman has said, this is a matter that touches deep sensitivities. I think that it would be better to conduct negotiations in my way rather than his.

Cable and Wireless PLC

The Financial Secretary to the Treasury (Mr. John Moore): With permission, Mr. Speaker, I will make a statement.
As part of their continuing programme of privatisation, the Government are now considering disposal of a further tranche of their shareholding in Cable and Wireless plc during the current financial year.
The Government renounced control over the company in October 1981 following the sale to the public of some 133 million shares. The Government's shareholding has since been diluted to some 45 per cent. of the company's issued equity as a result of an issue of new shares by the company in March 1983.
The Government have in mind a sale of approximately half their present shareholding through an offer for sale to the public. The precise timing and amount will be subject to market conditions. Parliamentary approval for the expenditure will be sought in a new Vote which will be presented to the House in due course. Pending that approval, the necessary costs of preparation for the sale will be met by repayable advances from the Contingencies Fund.
The directors of Cable and Wireless are recommending shareholders to agree to the issue to the Government of a special share which will enable the Government, irrespective of their own shareholding, to ensure the continuance of those provisions of the company's articles of association that limit the shareholdings of individuals and parties acting in concert to not more than 15 per cent. of the issued ordinary share capital. The Government will vote their shareholding in favour of this proposition.

Mr. Peter Shore: This is yet another sorry episode in the unfolding saga of public asset stripping which the Opposition call privatisation, and the use of the public capital so released solely to meet revenue requirements. A number of questions arise from this brief and inadequate statement.
Just how much money are the Government attempting to raise by the sale of this further tranche of shares? What method of share disposal will the Minister adopt to prevent a repetition of the disgusting profit making that we witnessed the last time the major tranche of shares was sold? Will he tell us what loss of income and profit the Government have already experienced on an annual basis as a result of the disposal already of about 70 per cent. of this remarkably successful and profit-earning public enterprise which they started to demolish about two and a half years ago?
What measures does the Financial Secretary propose to take to prevent this valuable, dynamic and to some extent strategic asset from falling into foreign ownership and control? What percentage of the shares are already in foreign control and how does this special share to which the statement refers guarantee against foreign ownership as distinct from the ownership by a single firm or enterprise of more than 15 per cent.? The last major statement was from the Minister for Information Technology, who is sitting next to the Financial Secretary. The Minister then told us that it was perfectly all right to sell up to half the shares because it would still leave the

Government the overwhelmingly major shareholder. That will not be the case now—far from it. The Minister told us:
As for foreign shareholdings, there are provisions in the articles of association that are of some value, but I shall consider that matter again."—[Official Report, 9 March 1981; Vol. 1000, c. 624.]
What consideration has been given to this matter? What guarantees can the Financial Secretary give that this major British asset will not be lost not only to the public Exchequer but to British national ownership?

Mr. Moore: It is unfortunate that the right lion. Gentleman allowed his words to ignore the reality in describing what is an outstandingly successful company
before, and more especially since, privatisation. It might have been suitable to have started his remarks with some reference to the employees, to the company and to their success in the market places of the world. The right hon. Gentleman might have wanted to draw the attention of the House to the fact that since the company was privatised its turnover has increased by 38 per cent. and its profits have increased two and a half times. The nation will benefit by the inordinate additional tax revenue from the increase of profits. I shall be pleased to give additional details later. The profits after tax have gone up from £35·5 million in 1979 to £108·3 million in 1983. In the 1983 fiscal year, which ends in March, the Exchequer has gained £48·4 million. In the fiscal year ending in spring 1982 the Exchequer gained £37·5 million. I shall give him the additional figures of the benefits to the nation of this successful company.
I am somewhat bemused by the right hon. Gentleman's question about the capital requirement. He should be reminded of the statement of his right hon. Friend the Member for Leeds, East (Mr. Healey) on 15 December 1976 when, in relation to the sale of BP shares and the usage of the money, he said:
There is one further step which we propose to take to reduce the public sector borrowing requirement in 1977–78."—[Official Report, 15 December 1976; Vol. 922, c. 1532.]
In the debate on the Budget statement the right hon. Member for Leeds, East said:
This sale will go ahead in 1977–78, and in framing my Budget proposals I have made full use of the room for manoeuvre which it will give me."—[Official Report, 29 March 1977; Vol. 929, c. 262.]
From where does the right hon. Member for Bethnal Green and Stepney (Mr. Shore) expect the Exchequer to receive money? I assume it is from increased taxes or increased borrowing, as opposed to the actions that his right hon. Friend took when in government.
The right hon. Gentleman also referred to the protections in relation to foreign ownership. It might interest the House to know that already 80 per cent. of the company's employees are foreigners. When the offer for sale originally took place, foreigners purchased shares.
The right hon. Member for Bethnal Green and Stepney asked about control. The controlling mechanisms to which my hon. Friend the Minister for Information Technology referred in September 1981 in relation to the nature of the company's articles of association will be replaced, providing of course the special share is approved. That will give exactly the same protection. If it will be of use to the right hon. Gentleman, I shall be happy to remind him of those protections.
The company has benefited and grown from its opportunities to be free from, as my hon. Friend the


Minister for Information Technology somewhat unfelicitously described it, the dead hand of the Treasury. In my present role I am not sure that I can subscribe completely to that remark.

Mr. Shore: Will the Financial Secretary answer my first and most important question? How much money is he seeking to raise in the further asset-stripping of this important enterprise? Secondly, will he make plain what is precisely the protection against foreign domination and ownership as a result of the further disposal of so large a number of shares?

Mr. Moore: On the amount of money, I cannot of course be specific even about the target because it would depend on the price of the sale at the time.
I also neglected to answer the right hon. Gentleman's question about the method of sale. The method of sale has not been decided at the moment. I remind the right hon. Gentleman of the recent success of the tender method in the BP sale. I remind him of what the existing articles provide:
Apart from Her Majesty's Government, no individual shareholder or group acting in concert may own or control more than 15 per cent. of the votes exercisable at general meetings of the company. The directors have power to require the owners' holdings that contravene the Article to sell the excess shares, or to sell such shares themselves on behalf of the owners.
Should the special meeting approve the recommendations of the shareholders including the shares of the Government, the special share, if then approved, will confer, irrespective of the Government's shareholdings, precisely the powers that protect from foreign control and changes in the articles of association.

Mr. Tim Renton (Mid-Sussex): Is it not only since privatisation that Cable and Wireless has changed from a slightly sleepy giant into just the type of dynamic enterprise about which the right hon. Member for Bethnal Green and Stepney (Mr. Shore) waxes so eloquent? Should not the success of the National Freight Corporation and Cable and Wireless since privatisation encourage employees in other nationalised industries such as British Telecom to seek similar freedoms for their own enterprises?

Mr. Moore: I could not endorse more my hon. Friend's remarks. It is especially interesting that since privatisation there has been no indication from the trade unions representing the employees of this now successful privatised company that they find relationships difficult. That is not surprising because most of the employees, happily, are now shareholders.

Mr. Richard Wainwright: Is it not a failure of stewardship by the Government that they should become committed to this sale of a public asset before the end of the year regardless of what may happen to values in a rather volatile market? Will the Financial Secretary explain why this sale should be precipitated by unexpected delays in privatising entirely different corporations?

Mr. Moore: The hon. Gentleman is drawing a series of completely incorrect conclusions. I am sorry that he cannot endorse the opportunities for people in the wider market place. I am sorry that he cannot see the opportunities within privatisation for the employees, let alone for consumers. No indication was given that this was

a precipitate sale. It is part of the Government's programme of privatisation. It is part of the process that is producing successful companies such as Cable and Wireless. I would not deny its previous success, but it might have been useful for the Opposition to mention its ability to grow even faster when privatised and to secure orders for its suppliers—critical suppliers such as STC, GEC, Racal, Plessey and Taylor Woodrow, companies which revel in the orders that a more successful British company can produce.

Mr. Michael Grylls: As experience shows that generally—indeed, almost without exception—the Government ownership of industries has done those industries nothing but harm, should that not encourage us to speed up allowing many of the remaining nationalised industries to have the advantage of private capital, rather than depending on the Government?

Mr. Moore: I look forward to the continued support of my hon. Friend and all my hon. Friends in the opportunities that can be given to growing British industries when they are able to tap the private market place and unleash the talents of all managements and employees through our privatisation programme.

Mrs. M. Beckett: In view of the housewifely exhortations to which the Prime Minister regularly treats the House and the country, will the Minister, despite his previous remarks, tell us in all candour what he would think of a housewife who continually, over a period of years, sold the family assets to finance the housekeeping budget? Will he reassure the House that the Treasury has some idea of how it will keep the finances of the country going when it has ceased having anything left to sell?

Mr. Moore: I do not share the hon. Lady's deprecating attitude towards housewives in our country, and I find it peculiarly sexist. I should have thought that a nation which had shown, by the unleashing of the energies of employees—not simply in companies like Cable and Wireless but, for example, in the National Freight Corporation—that increased opportunities for wealth can be so created, that would be welcomed by all. It would be extremely pleasant to hear somebody from the Opposition Benches suggest that the employees in this company who have benefited from the success are to be commended.

Mr. Barry Henderson: As my hon. Friend does not like the expression "dead hand of the Treasury", will he confirm that Cable and Wireless will now be released from the constraints of the public sector borrowing requirement, which might have resulted in the company not being able to invest as much as it could, and perhaps should, in its role as a major company exporting British products?

Mr. Moore: I should have said that I was not so much concerned with the dead hand of the Treasury; I was being somewhat particular and personal. I meant the dead hand of the nature of bureaucracy on the private enterprise spirit of a corporation. The company has been freed from that control since privatisation in September 1981. That, we believe, is a significant feature of the way in which it has exploded in terms of its turnover and profit.

Mr. Harry Ewing: Will the Minister accept that, although he quoted the articles, they refer only


to groups acting in concert and that it is entirely possible for the control of Cable and Wireless to pass into foreign hands? Will he explain why, if Cable and Wireless is now so profitable, to use his words, and is providing an increasing and continuing income to the Treasury, he should be so insistent on selling off an asset that is providing such a continuing income to the Treasury?
May I press the hon. Gentleman about the Department of Industry team of civil servants who have been in Japan of late? We have an internal document to prove that a team from that Department has been in Japan trawling the Japanese money markets to encourage them to buy British Telecom when BT is privatised in October of next year. May we have an assurance that that team has not been trawling the Japanese money markets in order to buy the shares in Cable and Wireless which the Minister is about to float?

Mr. Moore: The Minister for Information and Technology is present and does not signify that he understood the hon. Gentleman's last remarks, but I shall try to pursue the matter. The first point he raised related to the control powers under the special share. That has not changed the nature of the protection that is already in existence; the proposal would maintain the same powers, which are regarded as sufficient by the Government.
On the question about the sale of further shares, I should have thought that it was up to the Opposition to show why the state should continue to own a minority percentage in a company of this kind without needing additional control powers. I should have thought that the Opposition would like to see the money released so that, for example, we might be better able to pay for services such as the National Health Service.

Mr. Tim Smith: Is it not the case that all those associated with Cable and Wireless—not just the shareholders but the employees, creditors and customers—have benefited from the excellent performance to which my hon. Friend referred, so making his further statement very welcome indeed?

Mr. Moore: Absolutely. All of the 10,600 employees of the company merit our attention, not just the 1,500 employees in the United Kingdom. It is to their benefit and to the benefit of the consumer that I hope we shall address our remarks. I have sought to do so.

Mr. Ian Wrigglesworth: As one who saw the operation of Cable and Wireless from inside the Post Office and subsequently since privatisation, I join the Minister in paying tribute to the work which that company and its staff have done.
Will the hon. Gentleman explain the Government's motives more fully? As it is clear that the measure which he has announced today will not increase competiton in the telecommunications industry and as it will not any further remove the dead hand of the Treasury—because privatisation has already taken place—what is the true motive of the Government in selling more of the excellent investment in this stock? Is it not selling the silver to pay the household bills, as the hon. Member for Derby, South (Mrs. Beckett) said? If this money is to be raised by the Government, will the Minister give an assurance that it will be further invested in capital assets of the sort that are now being employed in Cable and Wireless?

Mr. Moore: I know that the hon. Gentleman means well, but he is obviously a long way from office. One day—I pray never, but one never knows—he may have to face the reality of having to finance——

Dr. David Owen: Answer the question.

Mr. Moore: I will endeavour to answer the question if those slouching below the Gangway on the Opposition Benches will be patient.
The hon. Member for Stockton, South (Mr. Wrigglesworth) may then want to consider that, while Government must spend money, they must also raise it, and the inevitable choices are between printing, borrowing and taxing. I should have thought that he would want to see a successful and free society, as opposed to the right hon. Member for Plymouth, Devonport (Dr. Owen), who mouths nonsensical phrases he learnt as a Socialist, such as "asset stripping". In creating for the employees and customers a vibrant and exciting new company. the hon. Gentleman should want us to give the public an opportunity to own even more shares in such an institution. I would have hoped that in his new-found freedom from Socialism, if that is what it was, the right hon. Member for Devonport might have joined us in this, but obviously he has not.

Mr. John Carlisle: In the past in such sales the Government have always attached great importance to the wish of employees to own shares in their company. What provision is the Minister making in this sale for that to happen?

Mr. Moore: As I said initially, the methods of sale have not yet been arrived at in detail.

Mr. Tim Rathbone: Will my hon. Friend explain, in view of the protections to which he referred, why the Government are not planning to sell all their holding?

Mr. Moore: The Government must concern themselves, when it comes to the time, with the market place, the necessary needs of other aspects of the market place, the needs of their overall funding programme, the needs of the company and the position of the company. The Government will be taking all those aspects into account when it comes to the precise amount of the sale.

Mr. Tim Eggar: In view of the obvious success of the denationalisation programmes of the previous and present Government, will my hon. Friend confirm once and for all and categorically that the Government will give top and overriding priority to further denationalisation measures of companies that at present are wholly owned by the State and will give top priority to selling off minority stakes in existing companies?

Mr. Moore: I can absolutely and unequivocally confirm to my hon. Friend that we shall continue to identify and prepare other potential candidates for privatisation, as this is clearly a key plank in the Government's programme of allowing competition to flow in our country and giving opportunities to the consumer. Obviously we shall continue to follow that programme.

Mr. Shore: This company has obviously been a major success as a public enterprise and it continues to be successful under its present private arrangement.
Surely the Minister can answer two specific points. First, he attaches great importance to employee involvement. What percentage of the present private ownership of Cable and Wireless is owned by the employees? Secondly, he must be able to give, if only for public sector borrowing requirement purposes, a broad order of magnitude of the sum of money which he intends to raise. If he cannot give that, there is no possible means by which the House can judge whether this is a sensible arrangement, even in the Government's own terms.

Mr. Moore: I cannot answer the right hon. Gentleman's first question specifically because the share position changes regularly, but I shall ensure that he has the figure. I could, of course, give a figure. I assumed that those who participate in these debates would be aware of the current price per share, which is 260p. If the Government were looking to sell up to half of their current 45 per cent. holding, and if we were to assume that there would be about 100 million shares, we would be talking about £260 million in gross proceeds. I reiterate that the specific size and the timing of the operation will depend on market conditions.

Times Newspapers

Mr. Ian Wrigglesworth: I beg to ask leave to move the Adjournment of the House, under Standing Order No. 10, for the purpose of discussing a specific and important matter that should have urgent consideration, namely,
new information concerning the Government's and the House's decision in 1980–81 regarding the acquisition of Times Newspapers by Mr. Rupert Murdoch.
In January 1981 the House debated the takeover of Times Newspapers by Mr. Rupert Murdoch. Despite opposition from both sides of the House, the House agreed to accept the then Secretary of State's recommendations that the takeover should be allowed and that the matter should not be referred to the Monopolies and Mergers Commission. It did so because of the alleged financial position of the newspapers at that time and because of eight conditions that were given to the House and attached to the consent by the Secretary of State.
The former editor of The Sunday Times and The Times has alleged today that the then Secretary of State grossly misled the House in 1981 in that the financial position of the newspapers was not as he stated and, therefore, that the matter should not have been exempted from reference to the Monopolies and Mergers Commission as required under the Fair Trading Act 1973. Secondly, he has alleged that the undertakings that were given to the House in 1981 by the then Secretary of State have been broken.
If these allegations are true, the House is being treated with utter contempt by Mr. Rupert Murdoch and his company. The then Secretary of State, who is now the Leader of the House, is the person to whom we look to protect the interests of this place. He is a fair man in the House and he is known for his honourable action in this and many other matters. Surely he should have an opportunity to say whether he was misled in 1981 and whether the House should take action to ensure that the undertakings that were then given are being carried out.
The House is the guardian of the public interest, especially in respect of newspaper power. I hope that you will think it appropriate, Mr. Speaker, that an early Adjournment debate should be held to provide an opportunity for the Government to say what they feel about the allegations that have been made and their actions in 1981, and to provide the House with an opportunity of casting comment and judgment upon the undertakings that were given by Mr. Rupert Murdoch, which apparently have been broken.

Mr. Speaker: The hon. Member for Stockton, South (Mr. Wrigglesworth) asks leave to move the Adjournment of the House for the purpose of discussing a specific and important matter that he thinks should have urgent consideration, namely,
new information concerning the Government's and the House's decision in 1980–81 regarding the acquistion of Times Newspapers by Mr. Rupert Murdoch.
The hon. Gentleman will have heard what the Leader of the House said during business questions this afternoon. I have listened carefully to what the hon. Gentleman said and I regret to say that I do not consider the issue that he has raised as appropriate for discussion under Standing Order No. 10. Therefore, I cannot submit his application to the House.

OPPOSITION DAY

[1ST ALLOTTED DAY]

National Health Service

Mr. Neil Kinnock: I beg to move,
That this House reaffirms its active belief in the principles of the National Health Service established by the Labour Government in 1947; pledges itself to maintain and to improve the standards of health care, free for all at time of use and need, to which the people are entitled; and calls upon Her Majesty's Government to reverse its stated policy of cuts in hospital and medical services.
The motion has been necessitated by three factors. The first factor is that we consider the National Health Service and its future to be an issue of paramount importance on the agenda of the nation. We are sad that, by her decision not to speak in the debate, the Prime Minister has made it clear that she does not share our view of the primacy of the issue. I understand that there are several explanations for the right hon. Lady's absence. They include the fact that she wanted to leave the Government's Front Bench participation in the debate to the experts. I could not understand why she was quite so bothered about that, as she manages in foreign affairs without the assistance of her experts.
Our second reason for tabling the motion for debate today is the systematic and persistent reduction in the real standards of provision in the NHS between 1979 and 1983.
The third reason for the debate is the intensification of the attack on the NHS by the Government since they were re-elected on 9 June 1983.
Concern about the NHS is not limited to the Labour party, either inside or outside the House. I know that there is concern on the Government Benches. I read the papers and I listen and hear. I hear the complaints of the hedgers who have been ditched. These include the right hon. Members for Cambridgeshire, South-East (Mr. Pym), for Chelmsford (Mr. St. John-Stevas), for Chesham and Amersham (Sir I. Gilmour), and now the right hon. Member for Guildford (Mr. Howell) has joined the honourable ranks of those who are continually offering their encoded messages and warnings to the Government about the way in which they are proceeding.
There are new figures on the scene. We now hear from the right hon. Member for Shropshire, North (Mr. Biffen), the Leader of the House, and the right hon. Member for Worcester (Mr. Walker), the Secretary of State for Energy. When issues about the welfare state and unemployment are raised, the right hon. Member for Waveny (Mr. Prior), the Secretary of State for Northern Ireland, seems to be in a permanent state of suspended resignation. I understand that when the onset of the cuts following the election became obvious, the Secretary of State for Social Services made it clear that he disagreed with them. We see him now on television justifying the cuts and wagging his finger. The right hon. Gentleman seems to be in a permanent state of animated suspension. His protestations that there are no cuts will not wash with us.
As I have said, concern about the NHS is not limited to either side of the House or to the House generally; it extends beyond this place. More importantly, it is to be seen with greater intensity and is expressed with greater

frequency by all the organisations that represent the health professions, including the Royal College of Nursing, the Royal College of Physicians, the Royal College of Surgeons, the Family Planning Association, the National Association of Health Authorities, Age Concern and all the trade unions. The list continues, and includes the Junior Hospital Doctors Committee of the British Medical Association and the BMA itself.
Recently, the secretary of the BMA said:
Many Authorities have been compelled to have recourse. to measures such as transferring moneys from their capital accounts in an attempt to meet the cuts without making immediate reductions in services to patients, and this may well have long-term serious effects on the Service. It is already clear that if the cuts are carried forward into next year there will be serious consequences for patients.
That was said not by a Labour party spokesman, but by an organisation that is generally not terribly generous or close to the views of the Labour party. However, it is united with us, as are many others, in unremitting antagonism to the way in which the Government are deliberately subordinating themselves to an utterly unrealistic economic and public expenditure policy, thereby seriously eroding the NHS, Britain's proudest possession.
The Secretary of State, who hears from the organisations that I have mentioned, describes them as vested interests. That is how he described them in his Conservative party conference speech. Yes, they are vested interests, but their interests are vested in patient care, healing and recovery. Those are the vested interests to which I should think the Secretary of State would want to listen. They have a vested interest not only of professionalism—the highest in the world—but of decency and altruism. The right hon. Gentleman should listen to those people.
Of course, the Secretary of State protests that he is not after those vested interests. He says that the cuts are after "the administrative tail". If his protests were valid, the people who should feel most reassured are the surgeons, physicians, nurses, auxiliaries—all those who demonstrably are not in any "tail" in the Health Service. They are what he calls the front-line personnel—the doctors and the nurses. However, those people are alarmed. They are not reassured by the Secretary of State's protests, or the protests of the Prime Minister, that the National Health Service is safe only in the hands of the Conservative party.Those practitioners are not reassured, because they are losing jobs, and they see the deteriorating services and the lengthening waiting lists. Day by day they are up against the realities of the consequences of cuts. Our motion has been tabled because of the testimony that we have received from those people of the contempt with which the Government are treating the National Health Service.
When I put that view the Secretary of State shakes his head and says that what I say is exaggerated. He points to what he calls
The NHS facts that give the lie to Mr. Kinnock.
The right hon. Gentleman said so in the Sunday Express last Sunday. He may seek to give the lie to me, but that does not fool me. What bothers me is the way in which the lie that he wants to give is accepted by so many people in the country.
Let us look at what the right hon. Gentleman describes as the facts in this article entitled:
The NHS facts that give the lie to Mr. Kinnock".
It says:


Fact 1 is that"——

Mrs. Jill Knight: Is it in order Mr. Speaker, for the Leader of the Opposition to accuse my right hon. Friend of telling lies?

Hon. Members: Oh!

Mr. Speaker: Order. That word was used earlier this week, and I made a statement about it yesterday. It is, of course, not in order for any Member to accuse another of telling lies in this Chamber.

Mr. Kinnock: I am sure, Mr. Speaker, that you were listening, whereas the hon. Lady clearly was not. I was quoting the Sunday Express. However I understand the hon. Lady's confusion when I use the words "Sunday Express" and "lies".

Mr. Speaker: Perhaps I should make the issue clear for the Leader of the Opposition and also for the House. It is not in order indirectly to accuse another Member of lying by attributing the words to others.

Mr. Kinnock: Wounded innocence is not an emotion that usually becomes me, but when the whole attribution is to me by a paper outside, it is difficult for me to accept your stricture on this occasion, Mr. Speaker.
The Secretary of State, referring to fact 1, said:
Spending on the NHS has risen 17 per cent. more than prices.
That is a rather selective view of the statistics. Indeed, it is over-simplification to the point of utter distortion. Let me explain the Secretary of State's own figure to him. He will know that if the figure is true, it is true only in relation to the retail price index, not in respect of medical costs. It is not much good making an evaluation of increases in expenditure in the National Health Service when the very things on which the expenditure is to be made have increased in price by double the amount of the retail price index. If the Secretary of State is such an observer of the truth, I am sure that the editor of the Sunday Express could have found another little line to put in there to qualify properly the statistic that the Secretary of State used.
Then there is fact 2, as the Secretary of State described it.

The Secretary of State for Social Services (Mr. Norman Fowler): Before the right hon. Gentleman leaves fact 1, is he denying that the resources that the Government made available over the past four years were sufficient to cover—more than cover—the demand through demographic growth in this country?

Mr. Kinnock: I can give the right hon. Gentleman the figures for growth of resources. I have them here: 7·7 per cent. alleged growth of resources, 4·5 per cent. of which was entirely related to demographic changes and 2·5 per cent. related to technological change, leaving what the Americans would describe as zilch for any advancement or improvement in the Health Service. If the Secretary of State wants to claim credit only for stagnation—just trying to meet the increase in costs of the Health Service in respect of demographic change—why has he tabled the amendment that is on the Order Paper claiming improvements? Clearly, improvements have not taken place. I do not ask the House to take my word for that, or even to take the Secretary of State's figures for it, because the figures that I am using are his. I ask hon. Members to

go to any hospital or surgery in this country and to look at any waiting list, to see whether there has been an improvement over those years.
Fact 2, said the Secretary of State, was that
the Health Service is treating more patients than ever before".
I am delighted at that. I share the Secretary of State's pride and delight in that fact. However, it hardly explains the fact that the number of people on the waiting lists, using the most recent figures, was 770,000. That is a record in British history. It is a recorded fact—a statistic that the Secretary of State manages conveniently not to include in articles in the Sunday Express or in speeches to the Tory party conference, even though he gives them in parliamentary answers.
Fact 3 is that
the health service is employing more front line staff like doctors and nurses than ever before.
That is fine. But the Secretary of State should acknowledge that the figures that he produced are largely a benign legacy from the arrangements that were made by the outgoing Labour Government of 1979—[Interruption.] They were the result of that Government's contract which gave nurses a 37½-hour week, and thereby required even that incoming Government——

Mr. Tim Eggar: rose——

Mr. Kinnock: —to add an extra 22,000 nurses.

Mr. Eggar: rose

Mr. Kinnock: Again, if that is not true, why does the Secretary of State permit that to be printed in Hansard in his name?

Mr. Eggar: On that point—[Interruption.]

Mr. Speaker: Order.

Mr. Kinnock: I am glad to give credit where credit is due, but I cannot give any credit. Neither I repeat, more importantly——

Mr. Tim Smith: rose——

Mr. Kinnock: —can those working in the service give any credit to the Government for providing resources.
It is the events since 9 June which have been most alarming, and which have prompted today's debate. Throughout the general election, the Conservative party studiously avoided making explicit promises about the NHS, relying only on the public expenditure White Paper of last February, which promised
cash provisions for 1984–85 and 1985–86 reflect increases of 5 per cent. and a further 4 per cent. over the higher provision made for 1983–84.
That was the phrase it used. Two days before the general election, on 7 June, the Secretary of State said:
these plans will be subject to further consideration and upward review. There is no question of a downward review taking place on the public expenditure White Paper figures already published.
We know now that was a premeditated falsehood—[Interruption.] In this debate we are talking about patient care, standards of health care and levels of provision. The fact is that since the election there has been—

Mr. Smith: rose——

Mr. Speaker: Order. I hope that this is a point of order, not an intervention.

Mr. Kinnock: —premeditated—[Interruption.]

Mr. Smith: Is the use of the term—[Interruption.]

Mr. Speaker: Order. I am waiting to know what the phrase is.

Mr. Smith: Is the use of the term "premeditated falsehood" by the Leader of the Opposition about my right hon. Friend the Secretary of State permitted?

Mr. Speaker: Order. I do not think that we should get too sensitive about this.

Mr. Kinnock: Obviously, there is dreadful overmanning in the Conservative party. Even Back Benchers have parliamentary private secretaries now.

Mr. Fowler: I am not in the least concerned about the phraseology that the right hon. Gentleman uses, but how does he justify what he has said, given that the figures that we used are precisely the same figures as we are keeping to?

Mr. Kinnock: If the right hon. Gentleman did not have such sensitive friends, I was about to inform him of that in my next phrase. Since the general election there has been not just a downward review—that would be a matter of small concern—but the delivery of three major blows to the NHS.
When we talk about resources, we are talking about the same overall amount and a retraction of resources for essential parts of the service. I shall tell the right hon. Gentleman why. We all know that the overall public expenditure figure in the public expenditure White Paper is being adhered to. Is not the star chamber sitting on it? Inside that fixed, rigid overall limit we now have a new theory. It is called a cash limit on the total NHS budget. The right hon. Gentleman knows what has happened. There was an overshoot of £100 million on the general practitioner service, which is beyond the Government's control. As a consequence, the Government decided to take that overshoot of £100 million out of the hospital services.
The first of the three major blows was on 30 June when the Government announced that the resources of the health authorities would increase by just 1 per cent. each year for the rest of the decade. The Government are well aware that that compares with the 1·2 per cent. that they said was necessary just to keep the NHS at a standstill. We have reason to believe, from a leak reported in the Financial Times, that officials believe that the figure should be 1·5 per cent., not even 1·2 per cent. The Government are not even providing the 1 per cent. that they said would be necessary. They will provide 0·5 per cent. because they say that the rest of the money can be made up by the magic efficiency savings. The Government are not even prepared to provide the 1 per cent. that they said was necessary to maintain a standstill.
In his announcement on 30 June the Secretary of State said that even that 1 per cent.
is not a commitment and health authorities must ensure that their plans are flexible enough to cope with more or less resources."—[Official Report, 30 June 1983; Vol. 44, c. 135.]
That was said by the man who is lecturing the Health Service on good administration and management.
The next blow to the NHS came on 7 July when the Chancellor of the Exchequer announced the public expenditure cuts, which included a cut of £140 million for the NHS. That was justified by overspending and came out of the same equation about the alleged overshoot on general practitioner services that I mentioned earlier.
Health Services, which is not an offshoot of Labour Weekly, suggested:
The Government was panicked into cutting the NHS on the basis of one month's aberrant figures for family practitioner drug prescriptions.
The DHSS has in any case consistently fixed the general practice budget too low by doing it in advance of the pay round. Dr. John Ball of the British Medical Association says:
When it happens once, that is chance. When it happens twice, it is coincidence. When it happens three times, that is enemy action.
That enemy action and the further enemy action by the Chancellor of the Exchequer means that NHS resource growth is now down to 0·21 per cent. of current levels of expenditure. That is nil growth at best, but what it really means is a big cut because of increasing patient demand, which vastly outstrips the resources that the Government are prepared to provide.
The final part of this modern disaster trilogy occurred on 26 July when the Chancellor of the Exchequer announced the first manpower cuts in the NHS since the 1950s. Up to 8,000 people were to be removed from the NHS work force. The Minister of State said:
We had already decided before the election that discussions and negotiations would go ahead with health authorities on manpower control.
However, they just did not tell anybody during the election. For anyone to suggest that there was any acknowledgement in any shape or form anywhere by anyone during the election that 8,000 jobs were to go is nonsense.
There has been a recovery since 26 July. Thirteen of the 14 regions protested. Consequently the Secretary of State is requiring the removal of only 4,837 jobs—just over 0·5 per cent. of NHS manpower. The real loss of jobs is much bigger than that, because the basis on which the figures were calculated on 31 March 1983 was that there was an extraordinary number of vacancies in the NHS, largely because of reorganisation. Therefore, the actual job loss is likely to be much nearer 12,000, or possibly slightly more. The right hon. Gentleman claims that the manpower restrictions need not lead to a poorer service. That is marvellous. With fewer doctors and nurses, the NHS is not a poorer service. That is a good equation, especially when there is not a big enough budget to expand on replacement technology for human effort in the NHS.
Doctor Rees, chairman of the hospital junior staffs committee of the BMA, said:
Patients can expect deterioration in availability of care, particularly in over-stretched services such as renal dialysis".
Any reader of The Times will know what he means by that. Any Sunday Mirror reader will know what he means by that. He also mentions special care baby units. Anybody who watches "Panorama" will know about that, let alone the unfortunate people who have children needing special baby care. He also mentions deterioration in
acute surgery, and in less glamorous but very necessary areas such as care of the elderly.
There is a vastly increasing number of the elderly. In addition, a threat now hangs over the general practitioner service.
When the Secretary of State spoke to the Pharmaceutical Society in July, he said that the Government could not permit unlimited expenditure
simply because there was a demand for it. We have to make sure we know what determines that expenditure and put ourselves in a position to influence more directly the factors by which expenditure is determined.


The Government influence the factors all right. They cut. That is how they influence the factors. Of course, the right hon. Gentleman claims that cuts need not follow from a combination of nil resource growth, increased demand and reduction in staff. There need not be a deterioration, although there is nil resource growth, fewer doctors and nurses, paramedics and ancillaries and a guaranteed increase in demand. There is a wondrous elixir called efficiency savings. We are all interested in efficiency. We must be. We all want value for money. That is excellent. Our hearts thrill at the prospect of an
improvement of standards of patient care".
That is what the amendment to the motion states. It should be combined with "prudence", one of the Prime Minister's and my favourite words.
Let us consider the efficiency promoted by the Government's policies. First, they have been efficient in increasing charges in the NHS by £321 million in the past four years—an increase of 200 per cent. Another of their brilliant ideas for efficiency involved charging overseas visitors for medical care. The Secretary of State said that those charges would provide a total of £6 million to help everybody else in the NHS.

Mr. Robin Corbett: Where is it?

Mr. Kinnock: My hon. Friend says, without rehearsal, "Where is it?" I, too, am beginning to wonder. No monitoring has taken place even though the figures for this first year's operation are supposed to be issued at the weekend, as the Secretary of State promised last year.
Let us examine the practical experience of hospitals. In the first six months of the year, the Royal Free hospital raised £167 from charging overseas visitors. The Royal Liverpool hospital, which has a great port nearby and could have expected many overseas visitors and casualties among seamen, raised just £71—[Interruption.] I see that help has arrived for the Secretary of State, from his advisers. Thank god for the cavalry!
Hillingdon hospital, which is the nearest big hospital to Heathrow airport, had a real boom year, by raising £778 from charges to overseas visitors. The fund is a bit short of £6 million. Bath district health authority, which I suspect is not under the control of the Militant Tendency, decided in July this year to drop all charges because it considered that the procedure was a fantastic waste of administrative time and effort and enormously inefficient.
What about prudence and privatisation? Those words thrilled the hearts of those at the Conservative party conference. During the past four years the Government have fastidiously encouraged health authorities to contract out. The consequence of such urging speeches by the right hon. Gentleman was that the expenditure on contract services for laundry fell by 30 per cent. and on cleaning by about 12 per cent. In September the DHSS told local authorities to put out to tender their requirements for laundry, cleaning and catering. Those are essential outlays for the average household, but the essential tasks of hygiene and cleaning in the NHS are now to involve the private sector.
Calderdale district health authority wished to build a new laundry costing £2 million. It would save £18,000 per annum by not contracting out, but the Government insisted that it would be cheaper to contract the work out.
The next problem involves the abolition of the fair wages resolution, which was introduced by dear Winston himself. How is it possible to get efficient labour when one pays low wages to the labour force? The workers are not the only people who object to cuts in their wages. The hon. Member for Stirling (Mr. Forsyth)—I do not know whether he is in the Chamber, but he is an expert on this topic—said that the Secretary of State was giving unnecessary ammunition to opponents by getting rid of the fair wages resolution.
Mr. David Evans, chairman of Brengreen, a cleaning company and a contributor to Tory party funds, accused the Secretary of State of astonishing political ineptitude. I wonder whether he will renew his subscription next year. Such people are afraid of the cowboys taking their work, and they are quite right. The Secretary of State's manpower restrictions on efficiency give local authorities a direct incentive to contract out, even when it is more expensive to do so.
Newcastle district health authority at present contracts out its laundry services. It has reported that if it could accept a tender from Darlington district health authority it could save £100,000 a year. However, such a tender would contravene the manpower restrictions because, to save £100,000 a year, the authority would have to employ 10 more people and it is not allowed to do so. Where is the efficiency saving in that procedure? How is the Health Service funded and operated more efficiently by that procedure? The Government's directive means that health authorities may have to accept unrealistic tenders. Once such a procedure begins, it is difficult to unscramble it. The teams in the health authorities are split up, the equipment is sold, and it is difficult to put things together again.
The magazine Laundry and Cleaning News—I do not know how often it has been quoted in the House, but it is an estimable organ—says:
A contract of some 8–10 years would be necessary to justify investment in new plant. Efficiency"—
that word again—
would not come into play for such long contract periods.
The magazine illustrates that the Government are concerned only with dogma, not with efficiency. It seems that contracting out can lead to poorer standards.
Crothall's—another contributor to Tory funds, incidentally—had a £200,000 contract with East Surrey hospital. The ladies who worked for that company simply mopped the operating theatres with wet cloths, so nurses had to reclean the theatres to the required standards. I am glad to report that that has now been changed.
How is it possible to guard against such incidents if the definition of "efficiency" is the lowest possible cost and the lowest possible wages? The process of tendering causes the NHS increased administrative costs which it cannot offset and which do not add to efficiency. Where is the efficiency saving? The Secretary of State drew cheers from the Tory party conference when he said that his plan was to cut administrative costs, thus freeing more funds for patient care. That claim was rubbish then, it is rubbish now, and it will continue to be rubbish because the Government do not promote efficiency by propounding that view.
The Conservatives have a poor record on efficiency. They voted to keep what Aneurin Bevan described as
the patch quilt of high cost paternalism


at a local level. They also voted to keep the national insurance system, even when an alternative was proposed, although that insurance system was the most expensive compulsory medical insurance scheme in Europe. That history has continued. They have shown a preference for the combination of private profiteering and Victorian philanthropy, which is the essence of ancient and modern Tory attitudes towards the NHS. Fortunately, there have been gaps in between. A different attitude may return some time, but it does not now predominate.
The Secretary of State wishes to make the Health Service more efficient. The Opposition concur with that wish. The problem is not whether the objective is achieved, but how it is achieved. It is difficult to squeeze the Health Service much harder in the hope of efficiency because it is already the most efficient medical system in the western world. I see hon. Members who have not used the NHS for years shaking their heads. The figures are not mine, but those of the OECD and of Mr. Maxwell, who is a recognised authority on this subject.
Those figures show that on any comparison with France, Italy or the United States, the administrative costs of the NHS not only represent a tiny 6 per cent. of total running costs, but are smaller by factors of three and two than any comparable service anywhere in the world. Why do we not have pride in that and build upon it rather than permanently prosecute the NHS—which is what the Government are doing? Our Health Service also takes a smaller proportion of gross national product than do the services in most comparable countries such as Canada, Australia, the United States and EC countries, except Greece.
Of course the NHS is not perfect, and we cannot say that we want to preside over waste. Of course we want to reduce any such waste and to achieve greater efficiency, but the fact remains that we are asking for more from the best in the world. The Government's policies show that they do not regard the opportunities for new and better care, new technology, care for old people and the saving of more children's lives as opportunities for investment in compassion, modern technology and efficiency, but as a burden upon public expenditure. That is their best attitude. Their other attitude is the recognition of pain as an opportunity for commercial exploitation.
Far from being a burden on public expenditure, the facilities and opportunities that modern medicine affords mean that the grave issues of life and death—not on a grandiose scale of war and peace but in the intimate matters of which child shall hear, which old person shall not be cold and which 55-year-old renal failure patient shall live and which shall die—are on the doorstep of modern Governments. Such issues cannot be evaded, as the Government are trying to do.
The Government should greet with joy—with rejoicing, may I say—the opportunity that they now have to invest in liberating people from the fear and insecurity of unnecessary pain, and its prolongation, which go with the waiting lists, the health cuts and the sackings of qualified staff. According to the British Medical Association, 3,500 doctors are now unemployed. That is an unmitigated crime against the British people.
Are the Government not prepared to learn that the British Health Service is not some attractive but expendable bauble that they can allow to decay? The Health Service is above partisan politics. It is cherished and will be fought for by people of all political views. The

Government should understand that the British people's affection for the NHS does not arise out of sentimentality. The public's affection is born out of its usefulness, dependability and utility. That is why they will fight to save it.
The NHS cannot be dismembered or dismantled by British Prime Ministers or foreign economists, because it is not theirs to dispose of. It belongs to the British people. They will strive to retain their proud possession because they depend upon, need and use it. They know that in defending it they are defending themselves. They are defending a service that is compassionate in its concept, efficient in its administration and effective in the alleviation of suffering. It is a service which now needs full-hearted and full-funded support to improve upon the superb level of patient care that it provides.
I beg the Government, not merely on behalf of the Opposition but on behalf of millions of people beyond. to reverse their policy towards the NHS and to invest in the combat with pain, the conquest of disease and the provision of facilities for the British people. If they do that, they will earn our gratitude, whatever political difficulty it might give us. There is something which lies beyond any disagreement that we can have in the House. It must be the extent of service for and the practical commitment to the welfare of all British people—every last one of them.

The Secretary of State for Social Services (Mr. Norman Fowler): I beg to move, to leave out from "House" to the end of the Question and to add instead thereof:
reaffirms its commitment to the National Health Service and to the maintenance and improvement of standards of patient care; congratulates Her Majesty's Government on the progress made over the last four years; and endorses its efforts to ensure the best value for money spent on patient care.".
One point is basic to this debate. Not surprisingly it is one of the many points that the right hon. Member for Islwyn (Mr. Kinnock) has ignored. It is simply that:
All social services have to be paid for in one way or another from what is produced by the people of Britain. We cannot create a scheme which gives the nation as a whole more than we put into it.
[Interruption.] I am sorry that Opposition Members do not like those words. They are not mine but those of Clement Attlee in a broadcast on the eve of the introduction of the National Health Service in July 1948. That, of course, was a time when the Labour party had a real leader—[Interruption]—and the badge of that leadership was that he was prepared to tell the public what was actually needed to sustain the Health Service and the social services of this country.
The basic charge against the right hon. Gentleman is not his inability to describe the problems of the Health Service. No problem has yet been invented which he cannot trip past with a glib phrase. [Interruption.] The real case against him is his total bankruptcy of ideas and of policies to deal with the problems he describes. He inhabits a land where the generalisation reigns supreme. [Interruption.]

Mr. Speaker: Order. The House listened with great attention to what the Leader of the Opposition had to say. It should listen with equal attention to the Secretary of State.

Mr. Fowler: That, of course, is why the right hon. Gentleman finds himself where he is today. He is the acceptable facade. He complains that the Prime Minister is not replying today. I am not sure why. Goodness knows why he should want to be knocked about three times a week and not just twice.
Let us get behind the right hon. Gentleman's generalisations and set out the facts about the Health Service against the charges he makes. He charges that the Government have cut the Health Service budget. The fact is that, even after taking account of the July measures, the Government are currently spending £15·5 billion on the National Health Service as compared with £7·75 billion in 1978–79. That is an increase of more than 17 per cent. against the retail price index. Those resources have been adequate to provide for the increase in the number of patients and demographic change.
The crucial point is that there is no merit in itself in spending money. Merit lies in what that money achieves. What really matters to the British people and to patients is what we get out of the money we spend on patient care. Once again the facts are clear.
According to the latest available figures, we were treating 640,000 more inpatient and day cases in 1981 than we were in 1978. We were treating 2 million more outpatients and emergency cases. We were treating 18 per cent. more geriatric inpatients and 14 per cent. more geriatric outpatients. We provided more than 2 million more courses of dental treatment. We gave 620,000 more sight tests. Almost 400,000 more people, many of them elderly, were visited at home. Those are the facts.
That means that more patients are today being treated than ever before, and that is the result not just of increased resources and of the skill and devotion of the staff, it is a result of the more effective use of resources inside the Health Service. By any objective measure, the Health Service has improved substantially during the past four years, and is continuing to improve.

Mr. Tam Dalyell: On several occasions I have brought forward private Members' legislation on the subject of renal dialysis. Could we have the figures for the waiting lists for renal dialysis, if they are available?

Mr. Fowler: I am coming to that point. The hon. Gentleman makes an entirely fair point about the many problems that the Health Service faces, and one of the most serious and difficult is that of kidney failure. The present position is that in 1981 we treated about 1,500 new patients, as against fewer than 600 10 years before. That is the measure of the improvement. The numbers increased by more than 50 per cent. in the five years to the end of 1981, and the number of kidney transplants performed in the United Kingdom in 1982 passed 1,000 for the first time, which is more than twice the number five years before and more than any other European country. Indeed, we have the specialist facilities now to increase the number of transplants substantially, if only we had more donors.
The right hon. Member for Islwyn also talked about waiting lists. He quoted, inaccurately, the present waiting list figures. The present waiting list is 726,000, compared with 752,000 in March 1979. What he should compare it with is the figure to which we brought it down in September 1981, which was 619,000. The hon. Gentleman must face the fact that two events that added more patients to the waiting list were the strike of 1979 and

the strike of 1982. Those two strikes added almost a quarter of a million patients to waiting lists. At least in 1979 the Labour Government—I pay credit to them for that—tried to do something about it, but in 1982 we did not hear at any stage one word of criticism of the industrial action that was hurting so many patients. That was the practical demonstration of the Labour party's commitment to patient care.

Mr. Kinnock: I am glad that the right hon. Gentleman brought up the subject, because I recall him saying previously that 3·1 million days were lost because of the strike in 1982 and that that was the reason for the longer waiting list. However, as he knows, the most recent figures show that 800,000 working days were lost, which we regret deeply. If he is worried about additions to the waiting list—140,000 people on the basis of 800,000 days lost—why is he not worried about the fact that the equivalent of losing 4,837 workers from the Health Service because of his cuts is one million days lost? How much will that affect the waiting list?

Mr. Fowler: That is an absurd analogy, but what I welcome in what the right hon. Gentleman just said is that this is the first time in the House that anyone sitting on the Labour Front Bench has regretted anything about the 1982 strike.
The next charge of the Opposition is that hospitals are being unnecessarily closed. That is an extraordinary charge—and something that was missed out of the right hon. Gentleman's speech—to come from the party that imposed the biggest capital cuts in the history of the National Health Service. Between 1976–77 and 1977–78, they cut capital spending by more than 20 per cent. Those capital cuts were the direct consequence of the economic policies of the Labour Government. The result of Labour's failure to develop social and economic policies together was a Health Service run by the IMF. The right hon. Gentleman knows full well—or certainly should know—that the Labour Government approved 272 hospitals for closure, which is more than twice the number under this Government. They also approved the closure of more beds. He should remember what the former Secretary of State, now Lord Ennals, said then:
The price of keeping surplus hospitals open is a lower standard of care than we could get by concentrating our hospital services to give a more efficient service to patients.
I do not deny for one moment that there are difficult decisions about hospital closures. It is part of my case against the right hon. Gentleman that he seeks to disguise the fact that there are difficult decisions that must be taken in the Health Service. We must make decisions about, for example, the small maternity hospital in Norfolk that was shown on "News at Ten" last week. A case can be made for keeping open such a hospital. However, it costs £150,000 a year; for almost a quarter of the year it had no patients; and the average number of patients is two. If the authority closes it, it will save over £100,000 a year in revenue and will gain a large sum in capital. Those factors must be taken into account by any Government worthy of that name.

Mr. Harry Ewing: This debate must be difficult for the Secretary of State, because he must be aware that he is making a very bad speech. No civil servant with any career prospects would have written that speech. Is the Secretary of State aware that the hospitals closed by


the Labour Government were old hospitals that had been replaced by new ones? The difference now is that the new hospitals that the Labour party built are being closed by him and his colleagues, and in some cases new hospitals are not even being opened. In Scotland the Government refused to fund 900 beds in new hospitals, as a result of which they stand empty and we cannot get patients in need into those hospitals.

Mr. Fowler: That is a foolish attempted rationalisation of the policies of the Labour Government. If the hon. Gentleman is serious about that, I shall ask my hon. and learned Friend the Minister for Health to read in full the speech that David Ennals, now Lord Ennals, made on hospital closures, which bears no relationship to what the hon. Gentleman just said.
The right hon. Member for Islwyn attacked us about manpower. The facts about manpower are that we employ more than 1 million people in the National Health Service in England, or 820,000 full-time equivalents. We are seeking a reduction in posts not of the 30,000 predicted by Mr. Bickerstaffe, not of the 20,000 predicted by the TUC, but of 4,800—just one half of 1 per cent. In judging that, we should remember that between September 1978 and September 1982 the number of staff in the National Health Service increased by about 70,000, or almost 9 per cent.
That growth was fastest in front-line staff—doctors, nurses and professional and technical staff. The increase in the number of nurses in the hospital and community health services of 46,000 increased nursing services and allowed a reduction in their hours of work. In England, there are now more than 5,000 more doctors than in 1978–3,500 in the hospitals and 1,700 more general practitioners. That is the background against which the Government's action over manpower levels should be considered.
We must also recognise that the Health Service is not only the largest employer in this country but the largest in western Europe. The pay bill accounts for 75 per cent. of revenue expenditure on hospital and community health services.

Dr. M. S. Miller: Will the right hon. Gentleman give way?

Mr. Fowler: No, I shall not.
There can be no effective planning for the future of the NHS without a clear understanding of the way in which manpower is used and the way it should be deployed in the future.
We inherited a system where manpower information was both inadequate and out of date. That was something we had to put right. Therefore, not last July but in July 1982, we asked health authorities to bring forward clear manpower targets for the year to 31 March 1984. Those plans showed not a levelling out of manpower, for which we had asked, but 7,000 new posts. The majority would not have been nurses or doctors. They would have been concentrated on the administrators, the ancillary staff and the work staff.

Mr. George Foulkes: Will the right hon. Gentleman give way?

Mr. Fowler: No.
We asked for those plans to be adjusted. In discussions with the regions we allowed for new developments, and

four regions are taking on extra staff. However, the total picture that has emerged is a reduction of just half of 1 per cent. of Health Service manpower—equivalent to about £40 million of expenditure.

Mr. Foulkes: Will the right hon. Gentleman give way on this point?

Mr. Fowler: No, I shall not.

Mr. Speaker: Order. This is an appropriate moment to inform the House that I have a long list of hon. Members who wish to take part in the debate. Interruptions do not make it easier for them, for me or for the Secretary of State.

Mr. Fowler: I have, Mr. Speaker, already given way several times.
I find it very difficult to believe that a service that employs 820,000 people, including 170,000 ancillaries and 105,000 administrative and clerical workers, cannot find manpower savings of 4,800. It is totally ludicrous to say that a saving of one half of 1 per cent. strikes at the foundations of the Health Service.
As the Griffiths inquiry said, and hon. Members should consider this:
better management of resources must mean better use of manpower".
There is a wider point. The Health Service is not a provider-oriented service. It is about serving the patients and the public, and not always in the hospital setting. Let us consider, for example, the problems of providing primary health care in our inner cities. That is a matter on which we received an important report from the study group chaired by Professor Acheson. Although we placed the main responsibility for action on those providing the service locally, we also recognised the importance of giving some special support. We have already given health authorities a total of £1 million for the training of health visitors and district nurses in line with the Acheson proposals, but there are other measures on which central action is now needed.
Therefore, I have decided that additional funds should be made available for new centres to create group practices in inner city areas such as London, Birmingham, Manchester, Liverpool and Newcastle. I have decided that there should be a 60 per cent. grant for the improvement of poor quality practice premises in inner city areas compared with the present 33 per cent. I have decided that other primary health care projects in selected inner city areas—for example, the development of night nursing services and improved supply of the aids and equipment used by district nurses—should also be improved. A total of £9 million will be provided for this initiative over the next three years. My hon. and learned Friend will give some more details when he replies.
Those steps are only part of our efforts to tackle the problems of primary care in inner cities, but above all they seek to demonstrate our determination to develop the Health Service to meet the needs of the community and of patients.
Those are some of the facts about the Health Service. The charges that the right hon. Gentleman makes are bogus. The policies he offers are empty because he has no realistic economic policy to underpin his social aspirations. Above all, the analysis that he offered today was dismally inadequate. Whatever divides the parties, let us at least be frank about the demands that the NHS will


meet. We must meet the increases in demand that will stem from demographic change, particularly the increase in the numbers of the very old, which will continue to rise sharply until the early 1990s, although it will slow down after that. We must meet increases in demand for the new treatments made possible by medical advance, although we should not forget that some advances can save money rather than add to the costs.
Those will be major challenges for the Health Service. They are challenges that other countries are now facing. Overcoming those challenges will require imagination and willingness to change. The solution to those challenges cannot just involve slogans and demands for ever more resources. We have provided extra resources, and as we have pledged, we shall be providing extra resources in the future. But it is also vital that we should develop further policies to extract maximum value for the money we use. That will sometimes mean savings on existing budgets. For example, the cost of drugs now prescribed has increased to almost £15,000 million. We must cut that bill.

Mrs. Gwyneth Dunwoody: What is the right hon. Gentleman doing about it?

Mr. Fowler: I shall tell the hon. Lady. With the cooperation of the pharmaceutical industry, drug prices were reduced by 2·5 per cent. from the beginning of August this year. That will provide a saving of £25 million in the drugs bill this year. I am now holding discussions with representatives of the industry on the scope for further savings next year. We shall be looking particularly at the profit rates that are allowed and the controls on levels of promotional and advertising expenditure. The industry has a good record as an export earner and I do not want to undermine those achievements, but we must also ensure that the NHS is not paying too much for its drugs.
Another example is the amount spent on catering, cleaning and laundry. That has risen to £900 million a year, yet until recently little has been done to test whether the in-house services that are generally used are giving best value. The Government's view is that there is no reason why those activities should be an unchallenged public sector monopoly. If a private firm can provide the same standard of service for less money, it makes sense to bring it in, particularly as the savings go direct to patient care.
We must also examine better ways of doing things inside the Health Service generally. There are enormous areas of spending in the Health Service. We spend £150 million a year on office equipment, telephones and printing and almost £300 million a year on energy costs. The evidence of performance indicators of local health authority spending shows, for example, that one hospital pays four times as much for its laundry to be cleaned as another and that it costs more than 30 per cent. more to run the ambulance service in one county than in the next door county.
The evidence of the audits show that one authority could increase its efficiency and save £80,000 a year simply by rationalising its stores. Shortly we shall have the evidence of the first Rayner scrutinies that are again likely to show potential savings in areas such as the use of transport and the storage of supplies.
Differences in performance such as these should raise questions for management, who should ask why those

differences exist and how they can be reduced. They cannot all be explained by the differing numbers of the elderly, local geography or the differing state of hospitals.
Above all, what the Health Service needs today is better management of itself. That is why I appointed Roy Griffiths to look into this question earlier this year and it is why I welcomed his report on Tuesday. By any standards, the Griffiths inquiry team was an experienced and distinguished group of managers, and included Brian Bailey with his trade union and health authority experience. I point out to the hon. Member for Crewe and Nantwich (Mrs. Dunwoody) who tried to interrupt earlier, that it is not so much that I find her public comments on this group an insult, which they clearly are, but that, above all, they are deeply ignorant.
The Griffiths inquiry team endorsed the initiatives that we have been taking to improve management performance, in particular the ministerial review of performance. It stressed the importance of decisions being devolved to managers capable of taking them and being held accountable for them. Griffiths is not recommending new tiers of authorities or administration; he is not recommending the establishment of two quangos in my Department. He is, above all, not recommending centralisation, but the very opposite. Devolution does not work if decisions are always drifting upwards.
His diagnosis is, first, that devolution will not work without an effective general management function. As he observed:
if Florence Nightingale were carrying her lamp through the corridors of the NHS today she would almost certainly be searching for the people in charge".
Secondly, he points out that if we could get good management at a local level we would have the opportunity of securing major cost improvement of a kind not so far seen in the National Health Service.
The right hon. Member for Islwyn talked about no further economies being possible, but I refer him to page 13 of the Griffiths report, which says:
Major cost improvement programmes can and should be initiated within the NHS, aiming at much higher levels of efficiency to be sustained over much longer periods than at present … It is almost a denial of the management process to argue that the modest levels of cost improvement at the present required of the NHS are unachievable without impacting seriously on the level of services".
Thirdly, what stands in the way is management, as Griffiths puts it, by lowest common denominator. The Griffiths team's advice is that we strengthen the process of consensus, which must still be the objective, by the establishment of a clearly definable general manager whose job it is to get things done.
The aim of the initiative is to make devolution work. We want all day-to-day decisions to be made as close to the patient as possible. I should have thought that that was an objective that would be shared by both sides of the House. Devolution cannot work if decisions have to be deferred upwards. It cannot work in the absence of an effective management process which means that the centre continually has to interfere. The Government are committed to the Health Service and will remain committed to it. We also want a modern service, a service equipped to meet the challenge of the 1980s and 1990s and not one where change is always seen as the enemy.
I am in no doubt about either the problems we face today or the problems that we shall face over the next few years. That is why it is all the more important that we get


the maximum value from the resources that we use and above all, the maximum value for the patients. We shall not be thanked in later years for ducking the decisions that need to be taken now to improve the Health Service.
The Labour party, behind the facade of a new leader, still offers no economic strategy and therefore no means of putting its hopes into practice. Worse than that, it refuses to recognise, let alone make proposals to tackle, the problems inside the Health Service itself. Their case does not deserve support. I ask the House to reject it.

Several Hon. Members: rose——

Mr. Speaker: Order. I have already told the House that I have a long list of right hon. and hon. Members—over 40—who wish to take part in the debate. I hope that this is a day on which all right hon. and hon. Members will bear that in mind when they make their speeches.

Dr. David Owen: I have lived all my life in a medical background. My father was a general practitioner and worked for over 25 years in the NHS. I was brought up to believe in two great freedoms—the freedom he experienced in 1945 when war was over and the freedom that he felt as a family doctor in 1948 when he no longer had to charge any of his patients for the care that he gave them. There are millions of people—Conservative, Labour, Liberal, SDP and Nationalist voters—who believe in the principles of the Health Service and who still look to the Health Service for their care and comfort.
I worked in the NHS for six years. I was Minister for Health for two and a half years and the proudest time that I have ever had as Minister, not barring the time that I spent as Foreign Secretary, was working as part of the team that increased by nearly 1 per cent. of the gross national product the resources put into the NHS. I look back at the Health Service, and I approach this debate with a deep sense of foreboding for the future.
With respect to the Secretary of State, and even the leader of the Labour party, who I am sorry to see has left the debate so quickly after having spoken in it——

Mrs. Dunwoody: He will be back.

Dr. Owen: I am glad that that is so.
The focus of the debate is on what happened after the general election in June. Much of the Secretary of State's defence rested on what he had achieved over the four years before the election. It would be folly to deny that there has been an expansion of resources in some significant parts of the NHS or that spending kept pace with the demographic pressures within the Health Service. My charge against the Government—I intend to substantiate it—is that for the first time in the history of the Health Service not only will there be an absolute reduction in the numbers of staff employed in the Health Service this year, but there is a real chance of no growth in real terms in health resources.
The Secretary of State is the first to point out the demographic pressures on the Health Service. Some 10 years ago, there were 2·5 million people aged over 75 and there are now 3·25 million. In 10 years' time there will be 4 million people over 75. The Health Service spends six times as much for each person aged over 75 as it does for those between the ages of 16 and 65. It has to spend 26 times as much through the personal social services. In this

debate no hon. Member should discuss solely the National Health Service. What is happening to the personal social services up and down the country is even more worrying.
In January 1983 the Government issued a circular entitled "Health Services Development: Cash Limits and Manpower Targets for 1983–84". It laid down the following cash limit targets for 1983–84. The revenue cash limit for the whole NHS was £8·4 billion. Allowing for an inflation rate then estimated at 5·5 per cent., that meant an increase in NHS services valued at £98 million in cash terms. In percentage terms, the Government were increasing the NHS budget by 1·2 per cent. in real terms. That was before the election. Leaving out the "efficiency savings" of 0·5 per cent., the Government were budgeting for an increase in NHS services of 0·7 per cent. in real terms for 1983–84. It was barely possible then for the Government to claim that they were safeguarding the NHS. Successive Governments have accepted that 1 per cent. inflation-proof growth in real terms is needed—many people believe that the figure should be 1·5 per cent.—to ensure that the NHS can stand still and keep pace with the demographic pressures from the elderly and the mentally handicapped as well as with the effects of modern medicine in enabling sick infants to live, often, to middle age.
In August 1983 the Government issued a revised circular, laying down revised cash limit targets for 1983–84. The revenue cash limit for the whole NHS was cut to £8 billion. Allowing for a reduced inflation rate of 4·5 per cent., that meant an increase in NHS services valued at only £17 million in cash terms, as opposed to £98 million. That represented a sharp reduction compared with the January target. In percentage terms, the Government have now decided to increase the NHS budget by only 0·2 per cent. in real terms for 1983–84. That figure still includes the January component of 0·5 per cent. "efficiency savings". Leaving that out, the Government are now budgeting for a net decrease in real terms of 0·3 per cent. in NHS services for 1983–84. That is not the action of a Government who promise to safeguard the NHS.
The other day the Secretary of State was manhandled by local health authority workers. They were wrong to do that, and the right hon. Gentleman called it a negation of democracy. In a way, he was right to say that. However, there are other ways of negating democracy. One of the most powerful ways of doing so is by going to the electorate on a platform that people believe in, saying that the Health Service will be safeguarded, and then cynically tearing up those promises within months or even weeks. That is what the Secretary of State has been forced to do by the Chancellor of the Exchequer.

The Minister for Health (Mr. Kenneth Clarke): rose——

Dr. Owen: I shall not give way as the hon. and learned Gentleman will have ample time in which to make his point when he replies to the debate.
In July, the Secretary of State announced that the NHS could plan for the next 10 years on the basis of approximately 0·5 per cent. real growth per annum, although he admitted that it would be difficult to manage that. That target was calculated on the basis of the January figures. However, the revised figures announced in the August circular have eroded the base position to 0·2 per


cent. growth, producing a revised figure of minus 2·8 per cent. growth per annum for the next 10 years. In other words, on the basis of the Government's most recently revised targets, there will be a sharp contraction in NHS services beyond 1984.
The Secretary of State has criticised the cut in capital spending with some justice, because the fabric of the Health Service is decaying and putting added pressures on the revenue budget. Indeed, capital spending accounts for only 6 per cent. of the total resources devoted to the NHS.
The effects of cuts on local authority personal social services are the most damaging and worrying of all.

Mr. Kenneth Clarke: rose——

Dr. Owen: I shall not give way. Mr. Speaker has asked us to be brief and the hon. and learned Gentleman will have half an hour in which to reply to the debate.
The figures in the January circular disclosed that the Government had estimated a net decrease in real terms of 1·3 per cent. in 1983–84 in total personal social services expenditure by local authorities in Britain. It is hard to make such estimates for a forthcoming year. However, the revised figures in the August circular demonstrate that the Government have now budgeted for, or anticipated, a larger net decrease in real terms of 2·4 per cent. in 1983–84 in total personal social services expenditure. No wonder that we all find in our constituencies that cuts are being made in meals on wheels and in the domiciliary services. In addition, it is increasingly hard to cope with the mentally handicapped patients, who have rightly been returned to the community, but for whom there are insufficient resources. Psychiatric and geriatric patients leaving hospital have to face inadequate community care facilities. Hard-pressed social services and social workers are having to refuse to provide much-needed telephones, and find that they are unable to meet the minimum requirements of the disabled. The pressures are building up, and that in turn will have an effect on the NHS. The Secretary of State knows perfectly well that joint financing—that most crucial measure introduced by us in 1975—is now barely able to fund projects that lie between the health and personal social services, because local authorities are unable to meet their revenue commitments.
I had hoped that the Secretary of State would say in his statement that he would somehow increase the facilities for joint funding. I welcome what he has done about the Acheson report. It is true that health care facilities in the inner city lack resources. But is the £9 million extra over and above the August figures for the revenue budget? Is it new money from the Chancellor of the Exchequer, or does it come from those "efficiency savings"? We have heard a lot about those savings. In Plymouth, a joint geriatric orthopaedic ward that was to absorb the orthopaedic work previously carried out at the royal naval hospital and so reduce waiting lists, will not now open although there is a four-year waiting list for outpatients. That means increased waiting lists, longer delays before treatment, pain for the elderly, immobility and further difficulties in keeping the elderly at home.
As a result of the combined effects of cash limits and manpower targets, Goucester health authority is having to postpone three priority schemes. I gather that a 24-place unit for mentally handicapped people that is ready to open will have to remain empty. A 12-place unit for severely

handicapped people, and a day unit for treating alcoholism will not open. We can all cite similar examples. For many years I have had some contact with the Hospital for Sick Children in Great Ormond street. I see the research workers and physicians who deal with leukaemic patients and with bone marrow transplants, and they are constantly worried about resources. The work is heavily dependent on "soft money" or voluntary contributions, and the hospital finds that it is unable to finance very necessary projects. Doctors belonging to the BMA, hospital consultants and family practitioners are openly admitting now that lives are in danger because of the shortage of resources.
I turn to the Secretary of State's so-called manpower targets and savings. The key point is that in the January circular the Government were working on the basis of an increase of 0·7 per cent. to 1 per cent. in overall staff numbers compared with that at 31 March 1982. That was then reversed in the August circular, with the Government looking for an absolute reduction of 1 per cent. in staffing levels between the regions. I often argued from the Government Dispatch Box that some hospital closures were necessary. Every proposal to close a hospital is rejected. Indeed, the best way of predicting the timing of a general election is to look at the way in which the number of hospital closures has fallen. That method never fails to point to the timing of an election. The first six months of 1983 were no exception to the rule. Hon. Members have not been realistic about the need to reduce some of the acute hospital services and to concentrate facilities. If the resources saved were directed towards geriatric hospitals or facilities for the mentally ill or handicapped, many of us would accept it, but the fact is that they are not channelled in that direction. Those reductions are absolute.
Why is this debate being held in the absence of the Secretaries of State for Scotland and Wales? Conservative Members should also ask that question. Why are those Secretaries of State not answering this debate? Why is this an English debate? The answer is that the manpower savings and the cackhanded way in which they were introduced in the middle of the year are unique to England. That raises some very serious questions about the competence of the Secretary of State, and particularly that of the Minister for Health.
There are serious questions about the way in which manpower savings have been implemented, let alone the case for them. No doubt the NHS needs savings, efficiencies and redeployment, but I fear that, as always, the Cinderella services suffer most—the psychiatric, geriatric, mentally handicapped and community services. That is the real charge against the Government.
The leader of the Labour party is still not in his place to listen to the debate. I hope that he does not think that the House gathered only to listen to his speech. If he concentrated more on the real issues he would carry more conviction in the country.

Mr. Willie W. Hamilton: Where is the Prime Minister?

Dr. Owen: I agree that the right hon. Lady should be here. If the alliance controlled the Supply Days it would have tabled a censure motion on the Government, and the Prime Minister would have been called to account from the Dispatch Box. We must worry not only about the snare of


the fowler, but what lies behind the fowler—we are after the thatcher. The Secretary of State has been forced to make these changes. In Cabinet he has had to concentrate on safeguarding the unemployed; he has had to look after the social security budget. I understand his problem in choosing priorities. It is sad that the health and social services must suffer.
The figures I have quoted are damaging to the Government. I am sure that they are accurate, but if they are not I hope that the Minister for Health will correct them in the greatest detail. The figures have been investigated with great care. It is the first comprehensive assessment of the real financial implications of the cuts. We are way below the minimum expenditure needed in real terms for this year—and projected forward for future years—to safeguard the NHS.
Will the Secretary of State again next year ask the Health Service budget to accept the overspend on the family practitioner committees and, effectively, the drugs bill? Is he prepared to do something about generic prescribing? Doctors in hospitals cannot prescribe just any drug. Unless the hospital consultant underwrites a specific drug, the hospital's pharmacist will provide the nearest equivalent. Of course, we cannot take away the rights of a hospital doctor or a general practitioner to prescribe certain drugs. But it should be made clear to GPs that usually a pharmacist will provide the nearest chemical equivalent unless the doctor specifically asks for a named drug. That would save substantial sums of money. There are other areas of health spending that need to be investigated, not least spending on advertising and so on. I am, therefore, not against any cuts or any savings.
I come to the management proposals for the NHS. I have lived with the problems. Three weeks after taking office I had to implement the arrangements made by the previous Conservative Secretary of State, now the Secretary of State for Education and Science. The scheme had to be operated by nurses, doctors, administrators and ancillary workers. They eventually built up consensus management. The present Secretary of State is now giving up all that. I warn him that establishing a general manager for every unit will bring severe problems. There is merit in nurses, doctors and administrators working together, although I accept that it is not always successful. Rather than implementing the general manager principle across the whole of the NHS—one more reorganisation being globally applied—why does not the right hon. Gentleman carry out pilot studies in a few areas where he feels that consensus management is not working? He could then come to the House in a year or two and, if it has worked well, say that he wishes to implement it throughout the country. That would carry more conviction.
As to the board that the Secretary of State is to chair, I urge him to bridge the gap between the Civil Service in the Elephant and Castle and the health administrators in the regions and districts, who understand the management of the NHS. He should bring them on to the management board and into the DHSS. The greatest problem has been the artificial separation between the Civil Service in the DHSS—which shifts between social security and other Departments—and those who have the nitty-gritty problems of handling the NHS.
It is time that the Government and the Secretary of State demonstrated that they believed in the Health Service. I wish that the Prime Minister were here. Would it not have been marvellous for the morale of the Health Service if,

when she had her eye operation—I am pleased that it was successful—she had had it in an NHS hospital and could have left it congratulating the hospital staff on its success? Around the world there would have been pictures of the British Prime Minister treated by the NHS. She would undoubtedly have received just as good treatment from the NHS, with its eye surgeons of international repute, as ever she received from the private sector. The right hon. Lady does not appear to understand that she is the Prime Minister of the whole nation. She appears to have an obsessive interest in the privatisation of everything. The market place is taken into health and education. For those reasons most of us fear her hand on the NHS. The indictment of the Government is that the NHS is not safe in their hands.

Mr. Steve Norris: I am grateful for the opportunity to speak on this important subject. I speak as one of the few Members of the House who are active members of a health authority.
I have the honour to represent the new constituency of Oxford, East which was created mainly from the wards of the old Oxford city seat, but to which have been added areas formerly represented by my right hon. Friend the Minister of State, Home Office and my right hon. Friend the Secretary of State for Defence. Both my distinguished right hon. Friends have earned the affection and respect of their former constituents over the years. I pay tribute to them for their support for, and hard work on behalf of, those wards.
It is a particular pleasure to pay tribute to my hon. Friend the Member for Oxford, West and Abingdon (Mr. Patten), the Under-Secretary of State for Health and Social Security. As hon. Member for Oxford since 1979, he gained the respect of his colleagues both inside and outside the House. He was one of the first new Members to become a member of the previous Conservative Government. I am delighted to see him on the Front Bench in his new role at the Elephant and Castle rather than at Stormont Castle. I convey to him the warmest regards of his former constituents who hold him in the highest esteem. I thank him for the countless personal kindnesses extended to me both before and after the general election. He has been a true friend and guide throughout my first weeks in the House, and I am sincerely indebted to him.
Specifically in the context of today's debate, my constituency houses some of the most impressive NHS facilties within the Oxford region, if not the country, at the JR2 John Ratcliffe hospital, the Churchill and the Warneford and Littlemore hospitals, among others. Health care is a vital issue to my constituents.
I have a great personal interest in the NHS and in health care delivery services, having been a member of the old Berkshire area health authority from 1979 until the demise of areas last year, when I was appointed to the new west Berkshire district health authority, of which I am currently vice-chairman. Working so closely with the health authority adjacent to my constituency and within the Oxford region has provided me with a most useful education in Health Service economics and management at a practical level. It has meant that I have been able to understand the implications of activity within the service in my constituency, and thus I hope to do a better informed job on behalf of those I represent.
On this occasion I feel strongly that it would be of benefit to the House to share some of the observations that come from operating close to the heart of the service from the realistic standpoint of those who bear the responsibility of carrying out the policy of the Government on a day-to-day basis. In all the great furore that has surrounded recent events, I have sadly heard all too little being said that was based in any way on a realistic understanding of how the Health Service is actually operating. It does nothing but damage to the NHS when the argument is all about emotion, and facts are ignored.
I shall confine my remarks, in what I understand should, by tradition, be a non-controversial speech, to the most recent event that has supposedly impacted so crucially on the NHS—the circular HC 83 (16) on cash limits and manpower targets for 1983–84. First, a criticism. I have to confess many misgivings, which are shared by those working in the NHS, about the application of the manpower targets. Those misgivings arise on two grounds. First, their imposition appears to me and many others in the Health Service to cut directly across the supposed increased freedom of management which was held out to be one of the principal benefits behind the recent painful reorganisation. While I welcome the statement that my right hon. Friend made to the House on Tuesday about the work of Mr. Griffiths and his colleagues, the management concept that he endorsed on that occasion as outlined by Griffiths, and with which I heartily agree, cuts right across the idea of arbitrary control of selected individual criteria in district management by the Department in London.
Categorisation has hindered rather than helped those of us who try to administer the Health Service. From what I can see, Griffiths has, if anything, pointed out the necessity to reinforce management structures. While that need not be taken to mean an increase in numbers, it makes nonsense of their being, in the main, of category "B" status.
Ambulancemen are another example of which I am sure the Secretary of State is aware, but I shall not go on. Equally, it is not yet clear—at least at district level—what power of virement we have between the two categories and whether there is still a firm requirement to reduce category "A" staff. No doubt my hon. and learned Friend the Minister will touch on that in his reply.
Frankly, I must repeat what I understand Mr. Griffiths to have said—that the less the Department tries to interfere in the day-to-day running of district and regional health authorities, the better for the NHS.
However, there is another and even more important aspect of this discussion of manpower targeting, and that is the effect on individual districts. I want to illustrate the position by referring to my authority. We agreed with the regional health authority in west Berkshire that a base line of 5,699 whole-time equivalents in March 1983 would be reduced by the princely number of 51. Those base line targets were produced for us by our quarterly computer print-out.
The authority met to discuss the position and two revealing facts emerged. First, by the administrator's own admission—I do not censure him or his colleagues in any way; indeed, their hard work and dedication to the Health Service over many years does them great credit—the authority was not in a position to know exactly

what its present manpower levels were so as to effect a comparison at today's date with either the assessment or the target. No doubt in due course the computer will reveal all—albeit several weeks out of date—but for practical management purposes the information was not available, and there is no real machinery for regulating a managed vacancy factor or a manpower watch monitoring scheme. Sadly, there never was a more self-evident justification for the emphasis that my right hon. Friend the Secretary of State has laid on the need to come to grips with the control of manpower in the Health Service. My authority will attach considerably more attention to that in future. It is remiss of us not to have done so previously.
The second fact to emerge, which it is important to remember in the context of what we have heard today, was that our authority probably—I stress "probably" because we are not sure of the exact figures—already had a staffing level that was possibly 100 below that set by the Secretary of State, because the normal mechanism of drag on recruitment processing generally comes into operation in the Health Service as elsewhere. Therefore, it will in practice be unnecessary to make any reduction in substantive posts in the health authority in order to achieve the targets set for 1984. That may be a reflection on the system of targeting employed. No doubt my right hon. Friend would be disappointed if the matter were to be allowed to rest there by my authority or by any other. However, it puts into perspective the extraordinary claims that somehow his action has reduced the Health Service to its knees and that we are now, as a result of these extraordinarily modest measures, incapable of operating the National Health Service. The reality of our example simply does not bear that out, as indeed my right hon. Friend has consistently and rightly maintained.
I am pleased to have had this opportunity to provide just a small local example—I ask the House to forgive its parochial nature—of what nonsense it is to suggest that the measure is anything other than modest in the extreme.
We have also been subjected to the budgetary adjustments that the Chancellor was recently regrettably forced to make on this year's allocations. Again, Oxford region and my authority were no more immune from those adjustments than any other. I have no doubt that some authorities have fared worse and others better, and I make no particular claim in that regard. However, the reality of an individual case may help to belie some of the screams of anguish that I hear regularly paraded before me in the House and elsewhere.
The Oxford region acted in a constructive and responsible way to absorb the budget adjustment by means of deferring some capital spending, extending the Milton Keynes commissioning period, and bringing forward some regional development reserves and unspent balances. Of the required adjustment, £300,000 was allocated to reductions in regional and district health authorities' cash spending. Net of joint finance money allocated to my health authority, the reduction required in west Berkshire was £36,000 against an annual revenue budget slightly in excess of £56 million, including those service developments which were initiated as a result of development money being available. At that stage in the financial year when we came to consider the £36,000, it was clear to us, as, I hope, a prudent authority, that we were likely to undershoot our cash limit not by a huge amount in relation to our total budget, but by sufficient to accommodate the £36,000 completely. In other words, the net effect on the


spending of the Health Service in the district is precisely nil. Our treasurer attributes the likely underspending to two factors: first, to the drag on implementation of structural improvements which we foresaw in our annual plan, which is not untypical of any organisation in the public or private sector; and, secondly, to the lower rates of inflation in outturn against our original budget forecasts.
That is the real picture behind the recent actions of the Government—a modest manpower proposal, the effect of which, in itself, is truly negligible, and a so-called cut in expenditure which amounts to no more in many authorities than an alteration to the technical underspend at the end of the financial year. Whatever else those measures may achieve, there seems little evidence here that they will produce anything like the effect for which they have, falsely, become so notorious.
There are two conclusions to be drawn, one by Conservative Members and another by those who have levelled somewhat intemperate invective at the Government. Conservative Members, believing as we do in the NHS, must be more vigorous than we have been in the past in putting across our clear message, if only there is a will to hear it, that the service is an excellent one in general and that we are determined to achieve better value for money from the immense and increasing resources that are committed to the NHS to improve patient care by more efficient delivery of service to the point of need.
As to those who are crying so loudly at this moment, I can only remind them of the cautionary tale of the boy who cried wolf. If the real and important negotiations over the future of the Health Service are conducted in such an unnecessarily hysterical fashion, it can only do harm to the service and patients for whom the complainants claim so heartily to care.
There are still large savings to be made and real economies are there for the making in the NHS. We can do much more within our existing resources to improve patient care standards as a result. The Government have shown their willingness to come to terms with the task, and I entreat those otherwise so ready to be critical to lay aside the inflated invective and join us in the constructive provision of an efficient and effective NHS for the British people.

Mr. Donald Stewart: I am glad to be called after the hon. Member for Oxford, East (Mr. Norris) because I want to congratulate him on his excellent maiden speech. He comes to the House with the extra authority of having been the vice-chairman of a health authority. Within the constraints of a maiden speech I think that all would agree that he made a robust and pertinent contribution to the debate. Therefore, we look forward with anticipation to his contributions in future debates.
Politics is essentially about priorities and it is abundantly clear where the Government's priorities lie. They lie in increased expenditure on armaments at the expense of a caring public health service and I hope that that is becoming clear. The Government's response to the problems of public expenditure is to attack the NHS by crude, short-term budget cuts across the board. The NHS may not be perfect, but since its inception millions of people have enjoyed the security gained from knowing that such a service exists and that the level of service does not depend upon their ability to pay.
I do not want to argue the pros and cons of private medicine, but without the resources of the NHS as the foundation and fallback security, private medicine would be dead because the costs would be exorbitant. Private medicine exists because of the NHS, and it is a parasite on the NHS.
Scotland has an unenviable record at the top of the international league for deaths from heart disease, lung cancer and other complaints. We should be increasing the resources put into the NHS, not cutting them. The need for better health provision is obvious. Only a Government totally devoid of compassion could, in cold blood, cut health expenditure. The cost cuts in Scotland have been made by a Government who had the backing of only one quarter of the population. As has been pointed out, Britain still spends a smaller proportion of its gross national product on health care than most advanced countries. That is the yardstick by which nations will be judged by civilised people.
In Scotland, hospital waiting lists have been lengthening rapidly and progress in reducing the waiting times in the past 10 years has been reversed. An increase in health expenditure of between 1 per cent. and 1.5 per cent. will be required simply to maintain the current position. Yet the Government go for cuts. The Glasgow Herald on 3 October 1983 stated:
So far, Scottish Health Boards have saved money and avoided pay-offs by freezing posts. The result of this policy has been less hostile publicity but a growing number of haphazard ward closures, longer waiting lists and overcrowding.
All the talk about the cuts of 0·5 per cent. and so on cannot disguise that fact. The people are aware of the realities, despite the arithmetic of the Secretary of State. The position is worsened by the cuts in social work departments which have been forced on Scottish local authorities by the Government.
The Government's proposal to health boards to contract out ancillary work is based not on efficiency but on ideology. It is a device to allow their friends in big business to rifle the public purse. The Government will use the abolition of the fair wages clause to reduce wages which are already abominably low. The case for privatisation has been proved wrong in the economic arguments. The Conservative manifesto boasted:
Even after allowing for price rises, the nation is spending substantially more on health, and getting better health care.
The Glasgow Herald pointed out that the reality in many parts of Scotland
is a return to the bad old days of overcrowded and understaffed wards and low morale even in some our showpiece hospitals.
The Government make a serious mistake if they imagine that concern for the future of the NHS is confined to the Opposition Benches. As the right hon. Member for Plymouth, Devonport (Dr. Owen) said, there is as much concern among Conservative voters as among other sections of the population that the service be maintained. The Secretary of State need not think that in bashing the NHS he will receive the plaudits of his supporters. Most people would regard expenditure on the NHS as having the first call on the national exchequer.
The Government must take several steps to safeguard the NHS. First, expenditure must be increased to provide for an updating according to the costs and the calls being made on the service.
The Government could also demand that generic drugs be put on prescriptions instead of expensive brand name drugs. The Secretary of State told us that he would have


consultations with the drug industry. If they are anything like the consultations that the Government have had with the tobacco industry, there is not much hope of advance. The Government could ensure a substantial improvement in public health and a lowering of National Health Service costs by banning tobacco advertising, yet they have never taken that step, which shows their reluctance to take on the tobacco firms.
Scotland's priorities are not the Government's. My party stands beside the doctors, nurses, other National Health Service workers and, most importantly, the patients in defence of one of society's finest creations which enhances the quality of our lives.

Sir David Price: I join the right hon. Member for Western Isles (Mr. Stewart) in his congratulations to my hon. Friend the Member for Oxford, East (Mr. Norris). We all agree that our debates are enhanced when people talk from personal, current experience. I shall not give my credentials; I believe that most of the House know that I have a close and continuing involvement with the National Health Service.
I shall put one general proposition to the House. The current challenge facing the National Health Service is one of expectations exceeding resources. I make no party point, but I believe that this situation has existed since the National Health Service was created. I believe too, and I am sure that the right hon. Gentleman will agree with me, that it is a great deal more fundamental than just a few per cent. more in resources.
When we talk about a free National Health Service we should be more careful to make a distinction and talk of it as being free to the patient at the point of delivery of the service. It is not free in terms of resources. We should make it clearer that it is a partnership that we must go on nourishing between taxpayers, all who contribute to the service, and all who use it. In many cases they are the same people but not as much as we sometimes believe. According to the Royal Commission on the National Health Service well over 60 per cent. of the use of the National Health Service is by people who, broadly, one would expect no longer to be taxpayers or who are too young to be taxpayers. It is important to maintain the partnership between user and payer.
The concept of a free and comprehensive National Health Service provided at public expense represents an open-ended commitment on the demand side, although the resource side will always be finite.
The demands on the National Health Service have clearly been stimulated over the past 30 years by the remarkable advances in medical science. We are increasingly able to alleviate pain and to treat conditions in areas previously denied to us. That has undoubtedly prolonged—if I may use an advertising phrase—active life. We all welcome and rejoice in that. It has, however, resulted in people remaining alive who are wholly or largely dependent for their daily existence upon other people. We think immediately of the very old and the severely disabled whose disability may date from birth. It is all admirable, but it has increased significantly the resource demands upon the service.
Many of us who care about the service have been slow to come to grips with increased demand. I hope that the new departmental Select Committee on Social Services will give that aspect of the service high priority.
I should like, in that respect, to quote to the House what I believe to be a useful document prepared by my right hon. Friend called "Health Care and its Costs". It states:
In some instances improved treatment methods can lead to net savings, because they reduce the need for prolonged hospital treatment".
We can all think of examples. The document continues:
but more often medical progress calls for increased expenditure. Innovations often extend demand by bringing more patients within the range of active treatment.
We think immediately of the hip joint replacement. The document goes on:
Many new treatments require more highly trained staff to handle the increasingly complex techniques, instruments and drug regimes involved, and this means that, in turn, manpower costs per case will often rise. New techniques and treatments may also mean the purchase and maintenance of expensive equipment. Additional costs will also rise because new treatments need careful monitoring: and some may entail a financial commitment lasting for the rest of a patient's life.
We welcome all this progress, but I do not believe that as a House and a society we have faced up to the resource consequences. I welcome the advances, but I wish that we would try to get a better measure of the consequences upon resources. I agree very much with what the right hon. Member for Plymouth, Devonport (Dr. Owen) said about the enormous importance of partnership between the National Health Service and the local authority social services. If we are to implement care in the community more, as I am sure all of us would wish to, we have to give greater consideration to the resources going into the community side of health care.
The right hon. Member for Devonport mentioned the over-75s. I do not think that his figures are quite right, but I do not quarrel with his broad thesis. The figures that I acquired yesterday from the Library show that in broad terms 3 million people in the community are over 75 and that over the next 20 years the figure is expected to rise to 3·8 million—a 20 per cent. increase.
On average hospital and community services spend nearly nine times—not six times—as much per head on people over the age of 75 as on people of working age. If there is to be a 20 per cent. increase in the number of people over 75 over the next 20 years, the forward planning of resources to meet this new demand will be daunting; but we cannot avoid facing up to it. Beyond the party badinage resulting from a new Leader of the Opposition, we must all consider how we will be able to provide the necessary resources, which I am sure all of us want to see provided, to fulfil the growing demand of the National Health Service. Whoever are the Government of the day, they have no choice but to determine priorities. It is easy to talk about priorities but it is harder to put them into practice. I hope that I carry the hon. Member for Crewe and Nantwich (Mrs. Dunwoody) with me when I quote what the previous Labour Government said in their health document, "The Way Forward". The right hon. Member for Devonport was probably one of the authors. They said:
Public expectations of the health and social services will frequently outrun supply and sometimes hard decisions will be needed to hold back some services to allow others to be developed.
This recognition of the need for priority should particularly appeal to the right hon. Member for Islwyn (Mr.


Kinnock), the new leader of the Labour party, who I understand is a great fan of the late Aneurin Bevan, who once said that priorities are the language of Socialism. I hope that the whole House will agree on the need for priorities. We should therefore look to the Social Services Select Committee for its advice on these very priorities.
We must not plan the future of the National Health Service outside the context of attainable economic growth within our economy, otherwise frustrated expectations will be even greater than I suspect they are now. Again, we have the evidence of the Royal Commission, which was set up under a Labour Government and reported to a Labour Government. The Royal Commission wisely observed:
The financial resources available to the National Health Service are finite … although we naturally hope that resources will continue to be made available on a generous scale it would be unrealistic to suppose that the fortunes of the National Health Service should be insulated from those of the nation.
That is fundamental if we are not to have a cleavage between expectations and what we can provide. Looking ahead, that is what worries me. If people think that there is frustration now, I invite them to consider that in 10 to 15 years' time there could be a major imbalance between demand and resources in the service.
The start was made on this matter under a process known as the resources allocation working party, which was set up under the previous Labour Government and continued by the present Government. We all know that the purpose of RAWP—to get a fairer allocation of resources between regions—was in principle accepted by everyone, until there was a movement of resources away from those regions which came out best in the analysis to those which came out less well. As I come from a region which was a beneficiary of this move, I shall leave the argument there. The London area, which appears to have been a loser under this change, does not find that in practice the principle with which it may have agreed in theory is quite so acceptable.
The search for efficiency in the service must not be a once and for all effort, made necessary by the immediate needs of departmental cash flow.
I believe that the better use of resources must be a continous process. Our service must be geared up to continuing improvement. The medical input of better treatment and so on will help to achieve that. But it should not be a once and for all effort.
Who should decide priorities within the Health Service? In England we have 14 regional health authorities and 192 district health authorities, yet they are all financially dependent on the Government. They do not have a completely independent existence. How do we decide priorities? I should like the views of the Select Committee on this matter. It is not enough to say that the Secretary of State decides in the broad. We must get down to where it really matters—resource allocation in the districts.
This should be decided as near to the patient as possible. That is why I strongly support the Government's proposals on direct personal management. In the hospital service today no one is in charge at any level. There are committees galore. I was once connected with a London teaching hospital and I remember that the ward sister was the linchpin of the organisation, because she was genuinely in charge of her ward. She may have been awkward at times but she ran a tight ship, to use a naval

expression. I believe that getting the ward sister and the matron back with their old powers is essential. This need not in any way cut across the idea of proper consensus consultation, but direct personal authority is essential.
I very much support the principles and the persons of general management in our hospitals. I wish them every success. I say welcome back to the matron and the 'ward sister.

Mr. Max Madden: Today and in recent weeks the Government have been dangling a series of assertions in front of the noses of the British public and now the Government and the Conservative party appear to be extremely unhappy, injured and upset at the British people steadfastly refusing to believe those assertions. The Government have been saying—the Secretary of State said it again today—that the National Health Service is the largest employer. They do not say—they in fact conceal—that the Government are sacking doctors and nurses to join other doctors and nurses on the dole. This is the first time that doctors and nurses in the Health Service have been sacked.
The Government say that there is more money in the Health Service, yet they conceal the fact that the resources in the Health Service are not sufficient to meet existing needs, still less anticipated needs. They talk a great deal about patient care, yet they conceal the number of hospital closures, bed reductions, manpower cuts and the way in which other forms of provision in the National Health Service are being reduced, all of which is having a direct impact on patient care.
Conservative Members criticise hospital administration, yet they conceal the fact—although we have lifted the veil a little today—that adminstration costs in Britain are a fraction of those in other countries with services comparable to the NHS. The claim by the Coservatives that the NHS is safe in their hands is not believed by the people, who have every justification to doubt their word.
If that is the case nationally, it is certainly the case in Bradford, West, which I represent. My constituents face the closure of Thornton View hospital, which for many years has provided excellent care for very elderly patients. The threatened closure is opposed fiercely by a wide range of individuals and organisations in the city of Bradford, including the community health council and Bradford city council.
When the closure of the hospital was originally suggested by the district health authority it was claimed that the saving would be about £433,000. We know from later information that that authority has before it proposals which could possibly save £462,000. Thus, the financial argument for the closure—the only argument that has been advanced—falls. In other words, there is no financial argument to justify the closure of the hospital.
My constituents argue that the alternative arrangements proposed for patients from Thornton View, if the hospital is closed, are wholly inadequate. The only long-stay provision of 23 beds is in ward 7 of Leeds road hospital, a pre-war hut-type building in an isolated location. It offers less light than the existing hospital, the sanitary accommodation is inadequate, it is as far from a bus service as Thornton View and the access to the hospital is just as steep. The district health authority would need to spend about £80,000 to put that ward into even a minimal condition to receive patients. The closure of Thornton


View would leave the authority with 59 fewer long-stay geriatric beds and 35 patients in wholly inappropriate accommodation.
I urge the Secretary of State—I have been doing so for some weeks—to meet a deputation from the city of Bradford so that he may learn at first hand the strength of feeling among, and hear the comments of, the local people about the closure of the hospital. I hope that before he makes an announcement about the future of Thornton View he will meet that deputation so that he may hear the full case for the hospital remaining open.
Thornton View hospital has been occupied by the staff since the early part of August. They have been anxious that the patients should not be transferred and their occupation has been supported enthusiastically by the local community, which is the finest vindication of the case for the hospital remaining open. I hope that the Government will see sense, will recognise the case for it remaining open and will announce that it will remain open indefinitely.
I come to some of the other cuts which are affecting local authorities and the impact they are having on the personal social services. The cuts are resulting in local authorities considering the closure of residential and other facilities for the elderly. There is a growing lack of these facilities, with great pressure on the places available. In Bradford, the health authority does not have sufficient long-stay geriatric beds, yet the general health of the elderly is extremely poor. There is little investigation into the needs of the elderly, who do not report illness or disability in the way that they should. We need an independent inquiry into the needs of the elderly in the city of Bradford.
Hon. Members have referred to the increasing numbers of very elderly people in the community. The number aged 85 and over in Bradford will increase considerably in the next 15 years. The people in that age range need seven times the resources of people aged 65 to 74. The closure of Thornton View hospital would result in a shortfall of between 52 and 66 beds, and if there is no additional provision in the next 15 years the shortfall by then will be between 90 and 104 beds.
As for the latest proposals for the reorganisation of the NHS, much has been said about the Griffiths report and the need for more efficient management. I appeal to Conservative Members to remember that we are talking about people, not bags of flour or packs of butter. These people are sick and in need of care. They should be treated with dignity. They have the right to expect the best possible care from the NHS.
In my constituency unemployment averages 30 per cent. In parts it reaches 40, 50, even 60 per cent., but I fear that some Conservative Members do not understand the impact of mass high unemployment in terms of illness and attitudes. We have acute poverty, with families suffering from depression as a result of family unemployment and fathers who have been unemployed for one, two, three years and more, and that has a big impact on community care because community care means family care. How can young mothers who cannot get their children into nursery school, because all the places are taken, be expected to provide proper community care for sick or elderly people?
In the city of Bradford babies are being weaned on baked bean juice, instant mashed potato and Cup-a-Soup. That is happening in many areas of high unemployment. Men must walk 10 miles for a £40-a-week job, yet they do not even have the benefit of a Tebbit bike. We in areas of high unemployment face years of poverty, the depression of mothers with young children and children continually ill through poor food and damp housing. That is the reality of Britain today.
Despite all that, the Government say that there are not the resources to devote to the NHS. They ask from where the money can come, and I will make some suggestions. They could find £10 billion if they choose to cancel the Trident nuclear submarine programme; they could find millions more if they reduced the burden falling on Britain because of our membership of the Common Market; and they could find millions more by refusing to accept the stationing of cruise missiles in this country.
It is interesting to note how the Americans are proposing to build hospitals in this country for American service men associated with cruise missiles. They are also providing scores of houses for American service men involved with those missiles. The Government could find millions of pounds by expanding the economy instead of squandering the North sea oil revenues to finance mass unemployment. They could find millions of pounds by not embarking on ludicrous proposals to reorganise local government. They could find millions of pounds by not imposing equally ludicrous civil defence requirements on local authorities. They could find millions of pounds by not giving large tax handouts to the very rich. They could find millions of pounds by not allowing unfettered overseas investment, thereby preventing more and more people from acquiring fine arts and property blocks in New York.
Those are some of the ways in which they could find more money for the National Health Service. Those are some of the ways that they could find more resources to build a better National Health Service. If they chose to find the money in some of those ways instead of creating more unemployment, more poverty, more misery and more depression, especially in inner city areas, they could greatly improve the NHS.
I am grateful for this afternoon's announcement that there is to be some increased provision for the inner cities—for the record, I note that the leader of the SDP, the right hon. Member for Plymouth, Devonport (Dr. Owen) left the Chamber some time ago—but I ask the Government whether the £9 million will be fresh money or money that will be juggled and removed from existing budgets.
Today, as yesterday, the Labour party is speaking for the people of Britain. I hope that the Government will heed what the people are saying. They are saying loudly and clearly—whether the Government have the wit to listen or heed is another matter—that they expect a proper level of resources for the NHS. These are resources to which they are entitled and which they know are available if the Government choose to use them.

Mr. Francis Maude: I cannot hope to match the rhetoric of the hon. Member for Bradford, West (Mr. Madden), who spoke with great passion. I am grateful to you, Mr. Deputy Speaker, for giving me the opportunity in this debate to make my


maiden speech. I am not quite the last of the new intake of Members to get off the mark, though the list of those who have not done so is gradually diminishing.
My constituency is more recreated than new. It has been absent from the political map of Great Britain for about 98 years. It disappeared under the hand of the Boundary Commission of 1885. I would be delighted to follow the convention of paying tribute to my predecessors from that time, but, even in the healthy climes of Warwickshire, North, I have not been able to find anyone who remembers them.
Warwickshire, North was created from two previous parliamentary seats—the old seat of Meriden and the old seat of Nuneaton. It has been used to a high standard of parliamentary representation. The old seat of Meriden was one of the most marginal seats in Britain and changed sides politically at each election. It had a series of talented and hard-working Members of Parliament, including my hon. Friend the Member for Ashford (Mr. Speed), my hon. Friend the Member for the new seat of Meriden (Mr. Mills) and, between them, Mr. John Tomlinson, who was my Labour opponent in June. All three of them served their constituencies and the House with distinction. They worked for their constituents most conscientiously and all are remembered in Warwickshire, North with gratitude and affection.
The Member who represented the old Nuneaton constituency, from which I have the town of Bedworth, was Mr. Les Huckfield, who I believe worked hard for his constituents wherever they were. I am sure that he will make his involuntary absence from the House a temporary one.
It is customary to talk about one's constituency and I find it a pleasure to do so. It is in the area of the west midlands which is precariously balanced between but excluding Birmingham, Coventry, Nuneaton and Tamworth. It contains a wide range of activities and occupations. There is an example of virtually everything except, I think, deep-sea fishing. There are four flourishing coalmines with industrious and extremely realistic work forces. There are many square miles of extremely efficiently husbanded farmland. There is a multitude of small, specialised and innovative engineering firms, about whose interests I shall have much to say on other occasions. It contains a number of towns and villages which are expanding and which are providing housing for people working in Birmingham and Coventry. All in all, it is a demanding, stimulating and delightful constituency which I am proud to represent.
The Health Service is increasingly perceived not to be short of resources. There is a mismatch between needs and resources. This explains the apparent paradox that there are too many acute hospital beds while there are still long but, I am glad to say, decreasing waiting lists. There are thousands of beds in acute hospitals that are not being used by those who need acute medicinal care.
About 20 years ago provision was made for people not in need of acute care in cottage hospitals, which we now have to call community hospitals. Nursing care was provided with overall medical supervision from general practitioners. In our wisdom, we chose to get rid of them, but they had many advantages. I believe that in future we shall have to look towards that sort of provision if we are to match needs to resources. The cottage hospitals were cheap to run and they were local. That was especially important in rural areas where people wanted to visit

elderly relatives in hospital. The fact that they were close to the areas that they served was an enormous advantage. They were small and because of that they were efficient and cheap to run.
The problem is to decide how we shall pay for that sort of hospital. We must look to much more effective management of resources within the Health Service. There are many parts of the service which are overmanned and it is folly to ignore that unfortunate fact. These areas are not overmanned only by ancillary workers. In some parts of the service there is an over-provision of medical resources and, as I have said, we must match resources to needs.
There is a massive inertia built into the present NHS management structure. I served for a short period as a member of a district health authority shortly after the reorganisation of the NHS. It took an extraordinarily long time for any changes to be made. I believe that the fault lay with the system of consensus management which arose in the early 1970s. No one person carried final responsibility for what actually happened. Members of the district management team took it in turns to act as chairman of the team, and that meant that the system had inefficiency built deep into its structure. I am delighted that the Griffiths report recommends the appointment of chief executives and general managers, who will carry the can for the units that they run. This is an essential step if we are to get inefficiency out of the system.
Many part-time members of district health authorities do a good job, but even those with a will to do so have difficulty in rooting out inefficiency. They do not have the time to do so and in many instances management is incapable of providing the information on which they need to act. It came as no surprise to some of us that in the recent review a number of authorities were unable to provide figures and information on the number of people that they employed. If anyone in the private sector tried to run a business in that way, he would not be around for long. It is astonishing that such a situation was allowed to continue for so long. It is a source of delight to me—and it should be to the entire House—that dramatic and radical action is being taken to improve the level of efficiency of management.
There exists an attitude which has fossilised the way in which we view the National Health Service. The idea seems to be propounded by Opposition Members that it is uncaring and uncompassionate even to contemplate the possibility that the Health Service is working at less than full efficiency. It is as though, in allocating money to the Health Service, one puts a label on it saying "NHS", and then one cannot follow where it goes. One cannot find out how it is spent. One assumes that because it goes to the Health Service it is automatically going to a good cause. One does not improve the Health Service just by pumping in money to make the statistics look better. The Health Service exists to provide a service to patients, and we must make sure that the money goes where it is needed.
It is therefore folly, when a private contractor can provide an ancillary service better than the direct labour force, to set one's face against it. The right hon. Member for Islwyn (Mr. Kinnock) made a number of points in his passionate speech about the way in which private contractors can operate. One cannot guarantee that a private contractor will provide a perfect service, any more than one can guarantee that a direct labour force will provide an adequate and efficient service. The difference


is that if a private contractor falls down on the job it is possible to replace him immediately. As the privatisation of ancillary services develops, there will be an increasingly large number of firms which are able to take on the work at short notice. There will be competition and efficiency in those important services.
Discussions about the National Health Service have been surrounded for some years by a cloud of muddle and cant. Now we have to tackle the real problem, not so much of shortage of resources as of making sure that the resources we have go where they are needed. That is the challenge for the future, and it is a challenge that the House must face.

Mr. Laurie Pavitt: It is a custom of the House to say kind words to a maiden speaker. I do so on this occasion with great pleasure for two reasons, first, because the hon. Member for Warwickshire, North (Mr. Maude) reminded us of our old friend John Tomlinson, who was well liked on the Labour Benches, and, secondly, because in the course of his first speech the hon. Gentleman came out with a Commons in-joke, which amused the House highly, and that rarely happens. I shall not repeat which one it was, because he will know.
I shall make only one comment on the content of the hon. Gentleman's speech. He is quite right about the concept of the community hospital. I invite him to pursue the matter further by getting from his hon. and learned Friend the Minister for Health the DHSS document "Community hospitals of 1974". That document would, in my view, repay study by him and by all hon. Members. It was a remarkable attempt to marry primary care with institutional care.
The only other thing that I shall say to the hon. Gentleman is the customary phrase that we all look forward to hearing him again, but I can tell him that, although he is a charming person, his hon. Friends will think that when he speaks they will not get the time to speak, and we shall think that when he speaks it will cut our time. We welcome what he said. He has a lot to say. We hope that he will have the opportunity to speak on another occasion, but that he will make his speech brief.
Much of our debate today has been about the way we interpret what the Government are doing about local issues, and that is right. Hon. Members have put forward their constituency cases. I speak as the Member representing Brent, which has a district health authority second to none, so the House will not be surprised if I, too, come constituency-wise. We see the division that exists. The Secretary of State and his hon. and learned Friend juggle the figures and give us much arithmetic and many statistics, but we all know that what they say does not match the reality in our own areas.
I am extremely worried about recent events in my area—not just the manpower cuts, but the whole way in which the matter has been handled. Brent is an example of the right hon. Gentleman's desire to have more and more power in his own hands and to exercise that power through his regional chairmen.
I am proud of the stand that my district health authority took in resisting the cuts. I want to tell the House of some of the consequences of that stand. People were appointed—not elected—to serve on the DHA to put patients first

and to use their local knowledge. They were not expected to dance like puppets when the Chancellor of the Exchequer jerks the strings of puppet number two—the Secretary of State—to conform with some economic and outmoded doctrine.
The round of cash cuts that we had was deplorable. Every authority, including Brent, has a year's estimates. Suddenly, after three months, to impose cuts was unforgivable. The manpower cuts were described by my right hon. Friend the Leader of the Oppostion. The number in my area was 110, but in reality it is 320 because, as we have a wise and prudent health authority, we had not filled posts. Posts were waiting to be filled. Now that prudence is being penalised.
I shall say a word about the consequences of the expenditure cuts. At the Central Middlesex hospital, much-needed equipment—an electrocardiograph machine, resuscitation machines, air flow fans, and other items for the use of patients—has had to be cut out. A sum of £1·2 million has been cut from the capital programme, and four wards will have to remain closed because of cash cuts. It shows beyond peradventure the truth of the statement by the regional medical officer of the north-west Thames region, that these cash cuts must inevitably cut into patient care, service, treatment and all that goes to make up National Health Service provision.
Government policy has led to one of the most inefficient demands on Brent's resources in 1982–83 amounting to nearly £1 million. We had to pay £529,539 for agency nurses, and a further £416,000 for other agency staff. That is entirely because, following the secondary reorganisation that took place, there was so much juggling of posts that the authority was unable to cope with the straightforward job of filling posts through the normal channels. Some of the 200 posts that are vacant are for nurses, while awaiting the outcome of the last reorganisation.
The district health authority's decison led to an unprecedented intervention by the regional chairman. It was the subject of a devastating first leader in the The Guardian under the heading
Dame Betty in a pickle".
Dame Betty Patterson is our regional chairman. There was an appalling blackmail threat, which I hope the Government will reject, to sack all members unless they were prepared to accept a diktat from the region. The members took the matter to the High Court, and Mr. Justice Forbes' comments are worth repeating. He said that if the region's counsel was right, it would enable a regional authority to
stampede a subordinate body into following its wishes".
He went on to say:
One approaches with a certain amount of distaste a system that envisages that the junior body is just a body of yes men".
Is that what the Government want? Is that the planning—that something comes from the Elephant and Castle to the regional chairmen and there are a lot of yes men with rubber stamps?
In this connection, let me quote the letter that came to all the dissident members last week from Dame Betty. It said:
I am, therefore, writing to inform you that a special meeting of the North West Thames Regional Health Authority is due to take place on next Monday 31st October 1983, which will consider seeking the consent of the Secretary of State to the termination of your appointment as a member of the Brent Health Authority".


To her credit, Baroness Cox, who was recently appointed, and who is a strong supporter of the Conservative party, was one of the rebels. I think that the Government thought that her appointment would be yet another method of having their own way. If the Secretary of State consents to the sacking of the members of the Brent DHA, he will make plain his own dictatorial ambitions. I remind the Secretary of State that the last king who claimed the divine right to rule was Charles I. When we take parties of schoolchildren around the House, we always tell them the story of the consequences.
The Government have accepted and approved urban aid for Brent, which is one of the most deprived areas in the country. At the same time they have cut funds in the rate support grant for the social services and back-up services in the NHS. The Government have demanded the reallocation of funds from Brent to Bedford. Brent has one district nurse for every 4,800 patients, whereas Bedford has one for every 2,800 patients. There are cuts in my area, but not in Bedford.
The Minister's style was typical in the nurses' dispute last year. Generally in the Health Service his style is "divide and conquer". In most areas, particularly mine, there is a threat to one hospital and another has to be sacrificed. The Central Middlesex hospital was under threat. Now the Wembley hospital is to be either partially or fully closed on the excuse that, if that is done, the Central Middlesex hospital will be preserved. I sought an assurance from the Minister for Health, but I did not get it. All he said was that there was
no formal application to close Wembley hospital".
The hon. and learned Gentleman did not say anything about the informal pressures behind the scenes. I look forward to hearing more about that.
The result of the last round of cuts is that 31 hospitals are earmarked for closure. At the moment 2,000 deaths from renal failure could be averted. That number will increase. As a deaf person, I am affected by the closure of the unit for the deaf, which is unique in this country, at the University College hospital. One of the illnesses that it dealt with, from which tny right hon. Friend the Member for Stoke-on-Trent, South (Mr. Ashley) suffers, is tinnitus. I could give a list of various illnesses and patient care that will be affected.
When the manpower targets are reached, 10,000 nurses will be on the dole. The Government have altered the way in which they collect the figures. I have been carrying out a six-monthly check. The figures that I want are no longer available. On my last check, the figure was 8,600 a year ago.
I accuse the Secretary of State of soft-soaping the nurses last year on their pay claim. The right hon. Gentleman made it clear that the nurses would not be worse off than the rest of Health Service personnel. The Government gave the nurses a pay award of 6 per cent. and then immediately gave the doctors 9 per cent. That was reneging on the Government's commitment.
In his report, Griffiths reveals a complete ignorance of the effect on the whole spectrum of nursing skill and on the patients. Instead of talking to Sainsbury and Roy Griffiths, the Secretary of State should listen, as I did yesterday, to people such as Trevor Clay, the general secretary of the Royal College of Nursing. I have his permission to repeat his remarks. He said that, in spite of the Secretary of State's denials in reply to a question that I asked last Tuesday, the proposal in the Griffiths report

represents a more massive change in human terms than either of the previous reorganisations of the NHS and the tier services that were too much at first and were then decreased.
Is the Secretary of State aware of the input of nurses at all levels of patient care? Is he aware of the millions of pounds that have been spent since the Salmon report on management training? Is he aware that all that has been discarded in the Griffiths report?
I should like to ask the Minister for Health two questions. He need not reply today. He does not always reply at the end of the debate, but he is always courteous enough to write to me afterwards. First, what will happen to the four chief nursing officers—one for each county in the United Kingdom—who, for the past 40 years, have been in direct contact with the Minister? Secondly, what is happening to the Whitley machinery? There is a great deal of discussion and reorganisation in all Whitley sectors of the NHS. Will the Minister make a statement about the stage that he has reached in the rearrangement and reorganisation of those staff negotiating bodies?
I offer the Minister some public expenditure savings. Generic substitution of prescriptions has been mentioned. At a stroke, I can save the Government at least £30 million and anything up to £200 million if, on 2 December, the Government tell the Whips not to block my Generic Substitution (National Health Service) Bill, allow it to have a Second Reading, and let other hon. Members support it in Committee. The Secretary of State says that he could now claw back £25 million out of the £35 million revealed by the Public Accounts Committee as being excess profits of the drugs industry. I hope that he will have another look at the debate on the unfair prescription charges for women who have had a breast amputated. Women pay £21·50 every year for the rest of their lives for chemotherapy. I ask the right hon. Gentleman to use his influence with the Cabinet so that cancer is added to the eight designated diseases eligible for free prescriptions.
Successive Tory Ministers have pursued NHS management. It is an obsession. Because of their knowledge of industry, commerce and the City of London, they think that all the answers can be obtained. There is nothing new about that. I have a copy of the "Grey Book". Fortunately, the Griffiths report did not cost us the £250,000 that the McKinsey report cost. Because the McKinsey report was unintelligible, it was necessary for the Department to produce the "Grey Book" to interpret it.
I advise the Minister to take his departmental working party to heart on this issue. Page 13 of the "Grey Book" mentions "Participation of clinicians". It states:
The management arrangements required for the NHS are different from those commonly used in other large organisations because the work is different. The distinguishing characteristic of the NHS is that to do their work properly, consultants and general practitioners must have clinical autonomy, so that they can be fully responsible for the treatment they prescribe for their patients. It follows that these doctors and dentists work as each others' equals and that they are their own managers. In ethics and in law they are accountable to their patients for the care they prescribe, and they cannot be held accountable to the NHS authorities for the quality of their clinical judgments so long as they act within the broad limits of acceptable medical practice and within policy for the use of resources.


I apologise for putting all that on the record. What was said in 1972 applies to the proposed executive managers and the scheme that will now be inserted into the NHS structure.
The Minister knows that our administrative costs are low. I shall not go into that argument, already covered by my right hon. Friend the Leader of the Opposition. Management is being considered as if it were an adding machine at a check-out. The patients having treatment in hospital are not being considered. I shall give an example of some of the nonsense proposed. Treatment for hernia takes two to seven days. When assessing the time needed, one has to consider whether the patient has had a colostomy or is elderly. Only the doctor can decide that. It would be nonsense for executive management to say that, because of the area, the time limit for hernia treatment must be two and a half days. such thinking would apply to every disease. Doctors' control is now challenged by the Griffiths report.
The Government's attitude is the same as the cynical adage of the medical profession. When the Secretary of State considers the NHS, he says:
Thou shalt not kill but need'st not strive officiously to keep alive.
In all its sectors, the NHS is being eroded. It is not being knocked down. Just as the upsets involved in the job changes caused by the previous reorganisation are settling down and just as the tremendous trauma in middle management and all specialties is resolved, the NHS will be shaken up yet again. The Government are perpetrating nonsensical acts on devoted and committed NHS personnel. The Government have found a prescription for setting doctors, nurses and auxiliaries against one another. They have now found a prescription for conflict in NHS middle management. From whichever discipline an appointment is made, there is bound to be a row.
I am afraid that the NHS will remain convalescent until such time as a Labour Government can restore it to health.

Mr. Nicholas Fairbairn: Like the right hon. Member for Plymouth Devonport (Dr. Owen), I have a medical background. My father was in practice with a cousin of Clement Attlee whom he frequently met in the early 1920s. I myself partially qualified in medicine and pioneered the birth control services of the Brook advisory centres in Scotland. When the right hon. Member for Devonport said that the greatest moment in his father's life was when he knew that he did not have to charge his patients, he seemed to suggest that thereafter nobody was charged for health care. In fact, the patient no longer had to worry about the charge, but the nation did. From then on everybody had to worry about the charge because we all became contributors to the National Health Service.
The Leader of the Opposition talked nonsense when he said that the NHS was the proudest and most priceless possession of the British people. Health is the most priceless possession of every person in this country. A service which helps those who are ill and restores them to health is also priceless—I wish that "priceless" was the right word in every sense—but it will be the nation's proudest possession only if the service is medically effective and not bureaucratically extravagant.
The virility of the Health Service is to be judged not by its expenditure, or by the global figure of those employed, but by whether it is a good medical service which everyone, whether well or ill, must pay for. We have doubled expenditure on the Health Service in the past four years, which means that we have doubled its cost. In the past 10 years the number of people that it employs has doubled. Although those facts seem to be good, that is not a good criterion to use. Political parties or Governments should not consider extravagance to be an achievement.
I hope that Scottish Members, especially the hon. Member for Fife, Central—I cannot remember the funny names since constituencies have changed——

Mr. Pavitt: Mr. Hamilton.

Mr. Fairbairn: "Hamilton" is not a funny name, but a funny person.
Scotland has a different NHS structure. The Government have looked after the nurses, the doctors and the services, but when a service spends more than a quarter of the entire budget of the Secretary of State for Scotland we must ask whether the money is being spent wisely and properly. The health board in my constituency spends two and a half times as much on ancillary staff and administration as it does on medical staff. That is a bad state of affairs.
I congratulate my hon. Friend the Member for Warwickshire, North (Mr. Maude) on his thoughtful and provoking speech. I was pleased to hear him refer to cottage hospitals rather than community hospitals. When asked to close a cottage hospital to save a tiny sum of money, the health authorities sought to take the money from the medical services and not from the administrative and ancillary services.
Ninewells hospital, in the Tayside region, has 46 miles of carpeted corridor and is the most expensive building to heat in Scotland. It is only two thirds full, it is inefficient and its costs are three times more than originally estimated. If the Leader of the Opposition had been Scottish instead of Welsh, he would have said that the NHS was spending money on Scotland's most priceless possession. Ninewells hospital is a monument of disgrace. What should have been spent on health was spent on bureaucratic empire building and extravagance. The Health Service must be examined in the light of such facts.
The NHS is a service of care, medicine, love and health for those in difficulty and need, and not for those who enter the medical bureaucracy to exploit, as I believe has been the case. Under the Scottish health boards are the area executive groups. Then come district executive groups, followed by sectors and units. Each of the separate area health boards costs £100,000, although they do not contain one person who will make a worthwhile or commanding decision. We are talking about the lowest common factor and the multiple of greatest expense.
The Scottish Health Service would have plenty of money if that money were well spent. Giving the Health Service more money will not necessarily improve the situation. The Health Service must improve the use of its undoubtedly adequate resources. The word "cuts" is a medical, surgical and statistical one. Some refer to economies or prudence as a term of abuse rather than of virtue. I take the simple view that the doctors who are not practising, the nurses who are not nursing and the administrators who are not involved in clinical matters


deliberately put pressure on the most sensitive areas so as to upset the public, worry the patients and prevent their empires, expenditure, staff and clinical enlargement from being diminished.
The secretarial staff for group practices and consultants is unnecessary and exaggerated. The number of X-rays taken, drugs given and prescriptions offered are out of all proportion to what any person who personally had to consider expenditure would ever medically and responsibly prescribe. There is unnecessary expenditure on everything in the Health Service except patients and the service. Health is the golden cow, not the Health Service.
All hon. Members want the Health Service to be better. Anyone who says that there is one person, country, sex or party who does not want it to be better is being unbelievably naive and cynical. The Health Service does not get better because it is more expensive, bigger, builds more hospitals, has more machines, employs more secretaries and ancillary staff or takes more X-rays. It can be judged only on its effect. I hope that the Leader of the Opposition's statement that pain is an opportunity for commercial exploitation will stand for ever in shame at his door. No doubt that will prove to be the pattern, level and thickness of his philosophy. For him, pain is an opportunity for political exploitation. He did not impress me as being worried about patients. He used patients and public concern as a means of making himself appear politically acceptable.

Mr. John Home Robertson: What about the cuts?

Mr. Fairbairn: What is wrong with cuts? If the hon. Gentleman had a wife who bought 1,000 fur coats, houses that she did not want and ran cars that she did not use and he said, "Would you mind spending the money on the children and not wasting it on all of this rubbish," would he describe that as cuts? I would say that such action was virtuous and an example of sensible housekeeping. It would be an example of someone minding about what they are supposed to mind about. The Health Service is supposed to mind about health and patients—not about the Health Service. The Opposition are not anxious about the welfare of all. They assume that officials are not corrupt, all-powerful or interested in their own empires. They assume that they are interested only in patients.

Mrs. Dunwoody: Would the hon. and learned Gentleman please retract the suggestion that anyone who works in the Health Service is corrupt? I am sure that he did not think about that statement. He does himself no credit to behave in such an extraordinary way.

Mr. Fairbairn: I am not suggesting that anyone is criminally corrupt. However, when someone says that he needs another secretary, office or more radiographers, is he considering the interests of the patient or his own power? That is what I mean by corrupt. There is such corruption in all bureaucracies, whether in private or public concerns. Such corruption should be controlled sensibly.
It is important that we spend properly the money that we take from citizens who might one day be extremely ill. That is the sacred trust for health. We must tell the Health Service, as the Government are doing, "Physician cure thyself."

Mr. Willie W. Hamilton: The hon. and learned Member for Perth and Kinross (Mr. Fairbairn) made many wild assertions and allegations about waste in the Health Service in Scotland and elsewhere. He also cast aspersions on the behaviour of my right hon. Friend the Leader of the Opposition. We shall not take any lessons in morality from the hon. and learned Gentleman.

Mr. Fairbairn: Or the hon. Member for Fife, Central (Mr. Hamilton).

Mr. Hamilton: My record on morality is——

Mr. Fairbairn: Pretty bad.

Mr. Hamilton: My record on morality will stand up well to a comparison with that of the hon. and learned Gentleman, so he had better shut up about such matters.
The now absent leader of the Social Democratic party implied that, because no statement on management structures in the NHS in Scotland had been made, presumably everything was all right. The Under-Secretary of State for Scotland should say—in a statement comparable to that made by the Secretary of State for Social Services today and not in a written answer—whether he intends to impose the same form of management structure that is being imposed in England and Wales on the Health Service in Scotland.
I agree with my right hon. Friend the Leader of the Opposition that we are under no illusion that a large service such as the Health Service—it costs about £15 billion a year to run—cannot be improved. I have sat on the Public Accounts Committee long enough to find gross inefficiency in the Ministry of Defence, let alone the Health Service. If we want savings, we should scrutinise defence spending rather than the possibility of employing independent contractors in the Health Service.
My hon. Friend the Member for Falkirk, East (Mr. Ewing) pointed out in an intervention that 500 brand new beds in Scotland remain empty and unused because the Government insist that there is no cash to pay the nurses and doctors necessary to service them, not because there is no demand.

The Under-Secretary of State for Scotland (Mr. John MacKay): Will the hon. Gentleman give way?

Mr. Hamilton: No. I get tired of participating it debates on the Health Service in which Scottish Ministers, who spend most of the time sitting on their backsides, want to intervene. If the Government want to reply to assertions made by Scottish Members, they should arrange for a Scottish Minister to reply during the debate.
Expenditure on the Ninewells hospital enormously exceeded the original estimate. It was built by private contractors—as was the children's hospital in Glasgow. It cost several million pounds and it virtually fell down a few years later. Costains built the Glasgow hospital with other private contractors. Litigation to determine who was responsible for that crass inefficiency and waste of money is now under way. Blame must lie with the private contractors as well as with the managers in the Health Service. The same will probably be true of the private contractors who are threatening to take over catering, laundering and cleaning services in hospitals.
Of course we want to have efficiency, but how can we measure it? I ask the Minister to confirm or deny that, for example, the fair wages resolution has gone down the


drain, so that the management is under no obligation to pay fair wages, but is under some compulsion to cut the wages of workers in the laundry, catering and cleaning services. There is evidence that some of them are reducing the sickness benefit provisions, holiday provisions and pension provisions of those workers. There is no doubt that they can get their services more cheaply by exploiting all those workers. I challenge the Minister to deny that that is happening and will happen increasingly when private contractors get their hands on the services.

The Under-Secretary of State for Social Services (Mr. John Patten): rose——

Mr. Hamilton: I shall not give way. The Minister will have half an hour in which to reply at the end of the debate, and I said that I would take only a short time.
This week we have had two major speeches from the Foreign Secretary and from the Secretary of State for Social Services. The Opposition have been equally impressed by both. Clearly we have a Government of all the talents, but I wish that sometimes they would reveal those talents. The two contributions from the Foreign Secretary, yesterday and the day before, and the Secretary of State's speech today are a sad comment on the calibre of Cabinet Ministers at the head of major Departments of state.
It was unfortunate that this afternoon the Secretary of State followed my right hon. Friend the Member for Iswlyn (Mr. Kinnock), because his was a brilliant speech of idealism—for which we should not apologise—and reality. It faced the issues as we see them—the need for efficiency, but the need for humanity and for more resources for the Health Service. There is no doubt that the service is suffering greatly right along the line from a shortage of resources, despite what the Secretary of State said. The Government talk about the Health Service being safe in their hands, and the Prime Minister went even further and said "only in our hands", but she takes care never to use it. She contracts out of the Health Service, just as she contracts out of using the railway system. When she practises what she preaches, we shall begin to believe her.
This afternoon my right hon. Friend said that all over Britain there is increasing evidence from professional people and ordinary working people in the service who are not normally supporters of the Labour party—including doctors, surgeons, nurses and ancillary workers—and from trade union leaders that they cannot cope and that patients are suffering. Patients and children are dying because there is no money to provide the services that they need. The Prime Minister is on record as writing to someone saying that the Government are sorry, but that children will die because the Government do not have the money to save them. However, they have the money. The Prime Minister, when faced with the Falkland Islands war, used the words "whatever the cost". There was no question then of tailoring our requirements to the economy, and within weeks £2,000 million of public money was committed to 12,000 people living 8,000 miles away, who were denied nationality by the same Government who now say that they are British people. That is hypocrisy and cant. The will is not there to provide money for the Health Service, and the Government intend so to starve the

service as to make it a second class service so that it will drive people into the hands of insurance companies and the private sector.

Mr. John Mackay: rose——

Mr. Hamilton: I shall not give way. The Minister should arrange to make a speech on the Scottish service when he gets the chance.
At present about 20,000 nurses and ancillary workers are unemployed. Nurses and doctors who have been trained at public expense cannot find jobs. I have a family example that I shall draw to the Minister's attention. As the House knows, I married for a second time a year ago, and my second wife's son-in-law is a member of the Royal College of Surgeons. He is 35 years old. He is a brilliant surgeon but he cannot find a job. He wishes to be a general practitioner and to do some surgery. He has been to Scotland and to various parts of England in pursuit of jobs, and some people have told him that he is over-qualified.

Mr. John Patten: rose——

Mr. Hamilton: I shall not give way.

Mrs. Knight: The hon. Gentleman is not interested in the answer.

Mr. Hamilton: If the Minister has an answer, instead of wasting my time now, he can write me a letter. If the Government have £9 million, presumably of new money—we have never been told whether it is new money—to establish group practices in the inner cities, how can my son-in-law take advantage of that? I hope that the Minister will go further and say that the Government will set up those group practices using only the 3,000 or more doctors who are now unemployed. I hope that the Minister will reply to that important point, because it is an outrage and an obscenity that those thousands of young men and women who have been highly trained at public expense are now in the dole queue. It is an indefensible position for the Government to sustain, and I hope that the Minister will answer the question that I have posed.

Mrs. Jill Knight: I never cease to be amazed by the Labour party. I never cease to marvel at the ease with which it distorts a picture to suit its case, especially if it is an emotional case. The House has been treated to a remarkable exhibition during the past 10 minutes, with an hon. Member making wild allegations while the two Ministers who could have replied to him directly were not allowed to do so. The "facts" put forward by the hon. Member for Fife, Central (Mr. Hamilton) cannot be very strong if he will not allow them to be challenged. He was not interested in the answers, and it is extraordinary that, especially when there is an emotional case, facts go out of the window and in comes the beating heart.
What are the Opposition talking about? Expenditure on the Health Service has more than doubled in four years. Surely no one, except someone who was rather unbalanced, could imagine that that represents poor treatment of the Health Service by any Government; but Opposition Members, never ones to let facts interfere with good knockabout speeches, roar, fume and posture like bogymen in a horror comic. They talk about savage cuts in the Health Service imperilling the lives and limbs of the populace, especially children. We have been told about that several times.
Opposition Members would all have a good future in Hammer Film productions. Vincent Price need not eat his heart out, but he has some close rivals coming up.
What are the cuts that we keep hearing about? There is a cut of 1 per cent. in manpower—

Mr. Fairbairn: It is only half of 1 per cent.

Mrs. Knight: Let us not over-egg the pudding. We should give a conservative estimate here. Are we really saying that when almost 1 million people are employed in the Health Service, a 1 per cent. cut in personnel will destroy the service? Anyone who really knows the Health Service must be well aware of the overmanning within it. There are scores of examples, such as overstaffing in administration, catering, portering and so on. Such instances have been brought to light many times by people from within the NHS.

Dr. Oonagh McDonald: Will the hon. Lady give way?

Mrs. Knight: No. I am talking about facts, and as we have had an example of bad manners——

Dr. McDonald: rose——

Mr. Deputy Speaker (Mr. Harold Walker): Order. The hon. Lady is not giving way.

Dr. McDonald: rose——

Mrs. Knight: This hon. Lady will not give way. I am giving the Opposition a taste of what it is like to have no one give way—[HON. MEMBERS: "What about the Birmingham hospitals?"] I shall tell hon. Members with the greatest of pleasure, because I have spent much time on them. Fairly recently, a constituent told me, "I do not know whether anything can be done, but along with four other ladies I work in an office in a hospital," which she named. She said, "There is enough work for one person in that office. The rest of us have very little to do indeed. One of the clerks was retiring and we told the administrator that there was no need for a replacement as the rest of us could do the work perfectly well." Unfortunately, that person was replaced—[interruption.]——

Mr. Deputy Speaker: Order. Hon. Members must desist from interrupting from sedentary positions. The hon. Lady has a right to be heard.

Mrs. Knight: I am obliged to you, Mr. Deputy Speaker.

Mr. Denis Howell: Will the hon. Lady give way?

Mrs. Knight: No, I shall not give way. Given the stories from people within the NHS, one wonders whether the 1 per cent. cut is enough. However, there is concern about whether the 1 per cent. cut in personnel is chopping in the right place. The public does not want a cut in the number of doctors and nurses only to be told that wards are closing through lack of medical staff.
My right hon. Friend the Secretary of State is often attacked unfairly. It cannot be said to be his fault if the number of nurses is cut in one hospital or the number of doctors in another. That is surely a matter with which the local health administration must deal, because only the local people on the spot know best where these personnel cuts should fall.
It was put to me yesterday that when personnel cuts are ordered, in some instances that can only mean a cut in the

number of doctors and nurses as they are the only personnel with short-term contracts. I hope that my right hon. Friend will consider this as it concerns many people.

Mr. Denis Howell: On a point of order, Mr. Deputy Speaker. The hon. Member for Birmingham, Edgbaston (Mrs. Knight) is making serious allegations about the conduct of the Birmingham central health authority, the chairman of which is her hon. Friend the Member for Derbyshire, South (Mrs. Currie), or at least was during the time about which the hon. Lady is talking. Is it in order for the hon. Lady to attack an hon. Friend over such waste without giving that hon. Member notice, in accordance with normal procedure, so that we can hear both sides of the story?

Mr. Deputy Speaker: I have heard what the right hon. Gentleman said, but I do not think that it is a matter for me.

Mrs. Knight: I am obliged to the right hon. Gentleman for raising that point of order, bogus though it was. It gives me the opportunity to say that the action of which my constituent complained took place six years ago, long before my hon. Friend had anything at all to do with the chairmanship of the area health authority.
There are 45,000 more nurses and 6,500 more doctors and dentists in the service now than there were four years ago. Therefore, what in heaven's name are we talking about? Labour Members must recognise that these are facts, and they can check them wherever they like. That 1 per cent. cut in personnel is the only cut that exists. Regional and district health authorities have their budgets and must keep within them.
The right hon. Member for Islwyn (Mr. Kinnock) suggested that it was dreadful to keep within a budget. Perhaps he never has to, but most of us do. The taxpayers would be extremely concerned if the Government did not keep within their general budget. It is right that local people should be in charge of where the budget is allocated. Some family practitioner committees have overspent, and their parent health authorities have had to alter funding to cover the overspend.
In fact, there has been no cut at all. I do not know what some hon. Members are talking about. My hon. and learned Friend the Member for Perth and Kinross (Mr. Fairbairn) talked about a wife buying many fur coats. I draw a parallel with the household budget of a mum who has blued £50 on a food processor. Readjustments will be needed in that household budget, but it is not a cut. There is no cut in the salaries going in, only that an extra amount has been spent that necessitates readjustments. Similarly, the Government have not cut health spending. It may be argued that they should have, but they have not. I am sick and tired of hearing about Health Service cuts. As I have said, expenditure has more than doubled in the past four years and there is no question but that we must spend the money much more wisely and ensure that there is no waste.
I admit that even if we stop all the waste we shall not get all the money we need to do all the things that we would wish, but we cannot afford the waste that is now taking place. I cite one example from the Moor hospital in Lancaster. Early this month it decided that it would stop issuing two cans of beer a day to its hundreds of patients, resulting in a saving of £10,000 a year. Labour Members may say, "What is £10,000? It is neither here nor there,"


but it was ridiculous to give those patients two cans of beer a day. That is the sort of waste that the Health Service simply cannot afford.
Recently in the annual Marsden lecture, the BMA secretary, John Havard, highlighted the amount of clinically unnecessary radiography that was carried out in the NHS. Once again, the evidence comes from within the NHS. He said that thousands of pounds were being wasted.
Everyone knows about the over-prescription of drugs. We are all aware of how serious that is. It is perhaps even worse in the family practitioner sector than in our hospitals, but without a doubt an enormous amount of money is spent on unnecessary drugs.
The National Association of Health Authorities in an interesting document recently drew attention to pilfering within the NHS, and earlier this year the conference of security officers within the Health Service estimated that at least £1 million a year was stolen from the kitchens alone. Not only were people taking sides of beef and pounds of butter and sugar, but many others were having meals to which they were not entitled. All this information comes from within the Health Service.
I am bothered about the wait that some patients who need treatment have to face, and all the inquiries that I have made show that frequently that wait could be lessened considerably if the patients were to go to another hospital for their operation. In Birmingham we have examples of people waiting a long time to go to the Dudley road hospital when they can have the same operation at Coleshill Hall hospital more quickly. I do not know why doctors do not direct patients to where the patients can be seen quickly. There are consultants working in St. Chad's hospital who also work in Dudley road hospital, but time and again patients seeing them have to wait many months for an appointment at Dudley road when they could have an appointment within two or three weeks with that same consultant were they to go to St. Chad's. Why can we not be more thinking and caring over the long time people have to face before their consultant's appointment or operation, and switch things around a little?
I welcome the Griffiths report on how to run the NHS with greater efficiency, particularly the part that stresses how, in all its travels, the Griffiths team met with such enthusiastic help from so many sources. It says:
We have faced no significant or serious objection to the general line of inquiry we have been pursuing and we have gained general support for our developing ideas … we have been besieged with evidence and points of view during and following all the many meetings we have attended. It is extremely heartening to find that so many people working in, or related to, the NHS care so passionately about the service and the way it should be managed.
My final quote comes from the British Medical Journal. I hope that Labour Members will read this magazine in the Library if they do not get it in the post. I shall draw their attention to the leading article in the BMJ on 15 October, in which the writer, a medical man, says:
While I strongly deplore arbitrary cuts in the NHS's budget and manpower, I have no doubt that resources can be used more effectively by doctors, nurses, and administrators, and the medical profession would be wise"—
so would the Labour party—
not to be swept along on a tide of political hysteria that threatens to engulf any practical and commonsense approach to establishing priorities … The reality of life is that individuals and institutions rarely make radical changes in their working

practices until faced by a cut in resources. To that extent this government may be—fortuitously or otherwise—doing the NHS a good turn.
That should be understood. Criticisms come from the people within the NHS, to whom we should listen. The Labour party has got it wrong again. It wants more and more money for the NHS—far more than people in the NHS are asking for—and it wants less and less supervision on how the money is spent. We can help the sick and elderly to the maximum only if we ensure that every pound in the NHS gives 100p worth of service. It does not at the moment.

Mr. Ted Leadbitter: During the past hour or so it cannot have gone unnoticed that some of the language that has been used in this debate does not reflect the real character and nature of the NHS. I was particularly sad to hear the word, albeit unchallenged, "corruption". The hon. Member who used it has a remarkable linguistic facility, but that does not get him out of the corner. Once he used that word, it marked him in his attitude towards the finest Health Service in the world.
The hon. Member for Birmingham, Edgbaston (Mrs. Knight) spent time talking about a spot of pilfering. More pilfering goes on in the House of Commons than in the NHS. There was a report in the press only recently about someone who is keen on pinching antique clocks from the House. However, let us not be diverted. People outside the House will make a judgment when they see the words that have been used here, because they show a regard for the Health Service that falls far short of what it should be.
My experience is clear. I have visited hospitals in the northern region—in particular, in Hartlepool—on a regular basis. I have a daughter who is a sister in one of the hospitals. I have had a lifelong political association with the National Union of Public Employees, which has a proud record in the NHS.

Dr. Brian Mawhinney: A quarter of a million added to waiting lists by strikes.

Mr. Leadbitter: Such comments are not worthy of the hon. Gentleman. People go on strike because they have to. The hon. Gentleman and I can afford not to strike. Let me hit that nail on the head straight away.
I have experience of doctors, nurses, surgeons and supporting staff—I do not call them ancillary workers—in the NHS. They are the cream of the working population in this country, in which I am proud to be living. Therefore, it is important that we address ourselves to accepting that description of the people who dedicate their lives to healing, to relieving pain and to producing—this has not been mentioned—a great contribution to our economic prosperity. The notional benefits to the economy are large. We are the richer if we recognise that the efficiency of industry is synonymous with the efficiency of the NHS in terms of its profitability. The aggregate of all that is to the national benefit.
We should spend less time talking about overmanning, as such talk is not justified. I have not been in an overmanned hospital. It is not fair to make a blanket charge of overmanning without some statistical evidence. I have not experienced it. However, I have experienced in-house doctors working atrociously long hours, as do the nurses. No hon. Member would like some of the experiences of the staff in our hospitals dealing with the


most difficult of cases. Not the least of these is dealing with drunkenness on a Saturday night, when the drunks are brought slopping into the hospitals and the low-paid nurses are given the job of dealing with them.
It should be a matter of concern to the House that many of our nurses are working in unprotected conditions. Some hospitals are isolated, even in towns and large conurbations, and, because of economies, there is no protection for the nurses at night.
It should be a matter of concern that in some hospital services, the catering facilities for nurses are shocking. What about those nurses who have to work overnight and their supporting staff? Those who work in hospitals should get together. There is a saying,
By uniting we stand, by dividing we fall.
In the past, Governments have been able to carry out measures in the NHS because of the divisiveness within the service. Those who work in the NHS must be brought together. Some of those who work, for example, on the 9 pm to 8 am shift have no catering facilities, other than perhaps an electric kettle with which to make a cup of tea.
Hon. Members should have some regard for the excellence of those who work in the hospital service, because they are very special people—la crème de la crème.

Mr. John Patten: So far the hon. Gentleman's remarks have concentrated on staff and staff welfare in the NHS, which is, of course, of paramount importance. However, perhaps he will now turn his attention to patients, because the NHS is run for them.

Mr. Leadbitter: If the hon. Gentleman does not mind, I shall make my own speech. With respect to the hon. Gentleman, I have been a Member of Parliament for 20 years and was in public life for 14 years prior to that, and I do not need him to tell me what to say. In this debate, experience lies with me, and inexperience with the Under-Secretary of State.
The National Health Service Act 1977 sets out strict and specific duties for the Secretary of State. Under the title "Services and Administration" part I sets out the Secretary of State's functions. The House should consider them carefully. The Act states:
It is the Secretary of State's duty to continue the promotion in England and Wales of a comprehensive health service designed to secure improvement—
(a) in the physical and mental health of the people of those countries, and
(b) in the prevention, diagnosis and treatment of illness, and for that purpose to provide or secure the effective provision of services in accordance with this Act.
The Secretary of State will no doubt say that he is doing just that. However, his view should be put on one side of the balance sheet and compared with the opinion of all the professional bodies involved. How does the right hon. Gentleman's view measure up to the great body of opinion expressed by local, district and regional health authorities? I suggest that the balance sheet is weighted most heavily against him. The professionals cannot all be wrong. It is not true to say that they are defending their corner or empire building. It has been suggested that administrators want first one secretary and then another one and so on. They are not involved in that sort of thing. It is a hard fact of life that the administration of our Health Service is better than the administration found in any other country in the world.
Surely the Secretary of State and the Minister realise that to challenge the judgment of the public and of all the lay bodies associated with hospital interests, such as community health councils and so on, amounts not to a rationale of the situation but to arrogance. It is foolhardy of the Government to sit hack and suggest that that great body of opinion is wrong. As hon. Members have pointed out, there can be no question of the money not being there. If the Government want money, they can stop building the airstrip on the Falklands. Steps have already been taken to negotiate sovereignty of the Falklands, so why in God's name are we spending £2 million or more on the Falklands? Millions of pounds are being spent, yet the Government are being mealy-mouthed about the most important thing in this land—the health of our people.

Mr. Barry Porter: As the hon. Gentleman will appreciate, I would not dream of telling him how to make a speech. Indeed, I am following his argument closely. The Secretary of State's balance sheet—as the hon. Gentleman has put it—should perhaps be judged by the amount of money spent compared with the number of people employed. I am a little confused about one point, which the hon. Gentleman may be able to clear up for me. Is not considerably more money being spent in real terms this year than was spent in 1978? I believe that 17·5 per cent. more is being spent in real terms now. Are not more nurses, doctors and dentists employed in the Health Service than in 1978, when the Labour party had control?

Mr. Leadbitter: The same could be said of 1966. In other words, it could be said that we were spending more in 1966 than in 1950. The reason is that the NHS has become a very important element in all our lives, and it must grow. The Government are heading for no growth in the NHS. Indeed, the hon. Member for Edgbaston was talking calmly about a 1 per cent. cut.
Is it not a great waste that thousands of doctors, teachers and nurses should be out of work? I shall cite an example from my constituency. Earlier this month an article was published about student nurses who were training in Hartlepool. The article states:
These 17 student nurses at Hartlepool General Hospital are worth nearly £360,000 to the National Health Service. That is the cost of training them for three years. Will it be money down the drain? The third-year students already know they will have no jobs by the end of the year. And the second-year ones don't have much better prospects.
The answer is that that training will be money down the drain. Where is the intellect that cannot grasp the elementary conclusion that it is a terrible waste of public money to train nurses, and then to say that we do not want them? It does not make sense for a health authority to be driven to such economies. Nurses are being lost; wards are scarcely manned. I have visited wards in every hospital in my constituency, so I know. Even the management has become daft by complying with the DHSS directives. In my constituency I am ashamed to say that hospitals—and they may be the only ones in the land or in the world—are being manned by nurses who have their caps taken from them to save a piddling £1,000. That is the craziness of it all. Such cuts are silly and irresponsible, and health authorities are not behaving responsibly towards their nurses and those who have given their lives to help the sick. That is a dreadful thing to have happened. One nurse who qualified recently and did manage to find a job said about nurses who could not find jobs:


It's a waste of money, it's a waste of knowledge, and it's a waste of us.
When the debate is ended people outside the House will assume that there has been a great discussion and that tomorrow we will turn our minds to other matters. While morale in the NHS is bad and pay for the majority of staff is poor, patients are full of praise for the care that they receive. We must not judge the debate on who has made a good speech and whether the leader of one party has made more impact than the leader of another party. The country does not want that. The people want a fair and just Health Service, especially for the young, those raising families and the old.
It is time to accept that politicking is a cancer. There is too much politicking with the NHS. Many hon. Members on both sides of the House love to talk about the NHS. They think that it is politically good to take one stance or another. Yet the majority of hon. Members do not have the knowledge or the facts, and to the outside world most of what they say is hot air. The Government are running a grave risk, because, for once, those in the NHS who are trying to look after the health of our people will not be pushed around to satisfy the dogma of any political party.

Mr. Christopher Hawkins: I am grateful for this opportunity to make my maiden speech. My predecessor, Spencer Le Marchant, represented High Peak for many years. He was a great character in the House and I know that he was well liked and respected on both sides as well as in his constituency. His contribution to the House was far greater than that recorded in Hansard. He served on numerous Committees and as a Whip for many years. As a result he was prevented from contributing to debate as often as he and the House would have liked. The House is poorer for his departure because of ill-health. I am sure that all hon. Members would want me to wish him a full and speedy recovery. [HON. MEMBERS: "Hear, hear."]
I shall briefly follow the traditions of the House before turning to an issue that I believe to be of great importance. I am greatly honoured to represent High Peak which, though a beautiful constituency, has lately suffered some severe problems. It is my job to fight for them. I know that it is traditional not to be controversial in a maiden speech, so although I feel strongly about the issue that I wish to raise I shall try not to strain the tradition to its limits.
This issue first came to my attention during May when I was a candidate at the general election. People living in Glossop complained that they were finding it difficult to get doctors at night and weekends. They were usually transferred to deputising services and frequently had to wait up to four and a half hours for a doctor, even for serious cases. They claimed that sometimes they were given poor diagnoses, completely at variance with those given by their own general practitioners on the following day.
I raised the matter with my hon. and learned Friend the Minister for Health and he visited my constituency and listened to complaints. I think that he was shocked by what he heard, and he offered to investigate the matter. In June The Sunday Times published reports of similar problems in London, and it became clear that it was a national

problem. During June and July I pressed my hon. and learned Friend for action, and in July I asked for an inquiry into the use of deputising services. My hon. and learned Friend said that he would set up an inquiry through the family practitioner committees. I was not entirely happy with that because those committees already monitor and control the deputising services. Unless it was to be merely a first step, it was almost like asking them if they were doing their jobs properly—a question to which we could confidently expect the reply "Yes, Minister".
I pressed my hon. and learned Friend further and asked for an independent body to be established to monitor and control the use of deputising services. I suggested that several laws should be introduced to require doctors in deputising services to have the same qualifications as general practitioners. They should have at least six months' GP training or its equivalent. I felt that the law should limit the number of hours that they worked in view of the allegations that some doctors from deputising services worked excessive hours to the point where no one could be confident that they could do the job properly. My hon. and learned Friend's reply to my requests was, in brief, "No."
Again, I was not happy and during the recess I decided to find out from inside the system what had been happening. I have been much helped by honourable people in the system who have provided me with inside information and papers. I now have extensive evidence covering a conurbation with a population second only to greater London. It includes Manchester, Stockport, Salford, Rochdale, Bury, Oldham, Tameside and also Glossop which is in my constituency.
I have clear evidence of excessive use of deputising services by a significant number of doctors. I have evidence that many group practices are using such services every night and every weekend, contrary to the code of practice. Most alarming, I have evidence that the requirement that professional advisory committees should be present at the interviews of all deputy doctors has not been carried out, other than when specifically requested by the deputising services. All this is contrary to the code of practice. All this evidence I have laid before my hon. and learned Friend the Minister.
I can go so far as to say that in some areas no monitoring has been carried out until recently. In fact, in some areas no system for monitoring exists. The doctors ask for permission to use a deputising service for a few nights a week. Having got that permission they can then phone the deputising service and extend cover to every night and every weekend. No checks of any kind are made.
In one area the family practitioner committee seeks to control the use of deputising services by imposing a limit of not more than 20 calls per month which may be carried out by deputies. I checked up and discovered that, contrary to the belief that people call doctors out for every minor ailment, the average number of night calls is less than one call per doctor, per week, in all the areas that I have mentioned: that is less than four calls a month. The control system allows for 20 per month which enables them, five times over, to use the deputising service every night and every weekend contrary to the code of practice.
In Glossop and other areas I have asked for data on response times—how long doctors from the deputy service take to get to each patient. I was told that the


family practitioner committee had asked for the same data but that they had not been forthcoming. What a control system!
I would now like to turn to what needs to be done. I am not saying that deputising services do not have a useful function. I am not saying that there are not many fine doctors doing a good job, working hard and looking after their patients. What I am saying is that some doctors are abusing the system and that the present system of monitoring and control is inadequate. My hon. and learned Friend has ample evidence that the present system of monitoring and control has failed. He has ample evidence to take action now.
The professional bodies that monitor the system are composed almost entirely of doctors and are sometimes composed entirely of doctors. Moreover, they are composed of doctors who themselves make extensive use of the deputising services and, in some cases, have shares in them. Their leisure and sometimes their income must conflict with their duty to monitor and control. We need an independent body, dominated by the public, to monitor and control the use of deputising services. We need a study group to recommend how to monitor and control as it is clear from my evidence that in many areas it is not known how to carry out those functions. We need a standard national system, reporting to an independent body. I am afraid that we also need a new code of practice which gives clear guidelines as the present code is unbelievably vague and woolly. It says that doctors should not make excessive use of deputising services, but it does not define what is regarded as "excessive".
Lastly, we should require by law that all deputies to be employed by deputising services should have the same qualifications required of any GP. They should have at least six months experience as a GP or the equivalent, and we should limit the number of hours that they can work.
I ask my hon. and learned Friend the Minister to consider those proposals so that anyone in Britain who has the misfortune to be ill at night or at a weekend can be sure to receive a speedy visit from a properly qualified doctor. Nothing less will do.

Mr. Donald Anderson: It is my pleasure to congratulate the hon. Member for High Peak (Mr. Hawkins) on his maiden speech, which deserves a clear answer from the Minister. He certainly does not have the grand physical stature of his predecessor but I am sure that if he keeps his speeches as short as he did tonight he will be held in no less affection by all hon. Members.
The debate has centred on the public's expectations of the Health Service against the background of an aging population, new and expensive techniques and an increasing drugs bill. Therefore, the question of priorities has arisen. With that background our main charge against the Government is that now is not the time, if there ever were such a time, to cut that Health Service, which they have done by 0·5 or 1 per cent.
The fault with the Health Service is not one of management—although there are faults and who will gainsay attempts to streamline management? The problem is not caused by privatisation of pilfering but by the need for resources and Government commitment to the Health Service, which its founding father, Aneurin Bevan, stressed

is a service where rich and poor are treated alike, where poverty is not a disability nor wealth an advantage.
An unfortunate signal was given to our people when the Prime Minister went into a private hospital for eye treatment.
Over the weekend, details were well leaked to the press about the battle that the Secretary of State has said that he has won in the Cabinet Committee on cuts. This battle, we are told, has resulted in unemployment benefit not being reduced in real terms. Is it not a shame that the Government considered cutting unemployment benefit in real terms when they have lengthened the dole queues so massively? That is hardly a great plus for any Minister, especially when in the other part of the Department health services are being cut in real terms as are the allied personal social services of the local authorities. This is causing distress to our population.
Macro questions have been discussed by both Front Benches. I was impressed particularly with the figures given by the right hon. Member for Plymouth, Devonport (Dr. Owen) from his experiences, and they deserve a reply.
I make no apology for discussing the micro element of health services and accepting the Minister's invitation to one of my hon. Friends to discuss the consumer's point of view. Consumers—the patients—are not worried about percentages; they are worried about the services that they and their children receive from the hospitals. I make no apology for quoting from a letter that I have just received from a constituent dealing with the Health Service. My constituent told me about her daughter Tina Wilkinson who
died of 'leukaemia' on the 18th July at Morriston Hospital.
She was 28 years old and the mother of a nine-year-old girl.
Tina died through lack of funds for the vital marrow transplant".
This would have saved her life. Her mother thought she was lucky because her younger sister was a perfect match.
She had been told she would have to wait until January because of the waiting list and lack of money. Leukaemia is a terrible disease which, unless one has watched someone dying from it, one would not appreciate.
She wrote to me as her Member of Parliament so that I could put forward in the House of Commons what has happened to try to help others.
Despite what the hon. Member for Birmingham, Edgbaston (Mrs. Knight) has said, this is not some Hammer horror film production. Is this mother ignorant, as the Minister might have it? Can she not recognise the benefits in what the Government have done for her? How do I explain to this constituent the 0·5 per cent. cut in the NHS, the increasing waiting lists and that the Government are prepared to spend £200 million on constructing an airfield in the Falklands when my constituent's daughter has died because of a lack of funds? I should appreciate the Minister's assistance on this point.

The Under-Secretary of State for Wales (Mr. Wyn Roberts): The hon. Gentleman has referred to one of his Welsh constituents. I am sure that he will allow me to put the record straight, about the Welsh part of the NHS. Since 1979, there has been a 9 per cent. growth in resources above the increases in pay and prices and after the July reduction. This year, there is an increase in the funds available to the NHS in Wales over last year's increase.

Mr. Anderson: That is even more shameful. There should have been a bigger increase, because the Minister must know that simply to keep pace with the demands of an aging population, the drugs bill and new medical techniques we need far more than that every year. Over the period this Government have been in office there has been a decline in the Health Service in Wales, but not just in Wales. I mentioned the sad and tragic case of that vivacious young mother of 28, but the Minister should go to the Westminster hospital, not far from here, and see the 45 children who are waiting for similar treatment and who may well die because of the Government's inability to find the necessary resources. Those are some of the human statistics that belie the "Never had it so good" complacent view that we have had from the Government Front Bench.

Mr. Roland Boyes: The guilty men.

Mr. Anderson: They are the guilty men. If the Minister wants me to refer to Wales and the increases that he alleges there have been in the Welsh budget, let me refer him to the West Glamorgan health authority. He knows that West Glamorgan must reduce its expenditure by £500,000 by 31 March next year and by a further £778,000 between March 1984 and March 1985. How will that be achieved? First, by not appointing a badly needed consultant chest physician. The Minister is aware of the incidence of chest diseases in our part of south Wales from industrial causes. It will be achieved by cutting care for geriatrics in an aging community, and the already scarce health provision for the mentally handicapped—[HON. MEMBERS: "Lies".] Is my health authority telling lies about what it must do because of the pressure for cuts from the Government? The cuts being forced on my health authority are replicated in every health authority. Let the Minister deny that.

Mr. Wyn Roberts: rose——

Several Hon. Members: Sit down.

Mr. Anderson: I am not giving way. The Minister will know that, like Scotland, Wales has a high incidence of cardiac diseases and the worst resources. What is the Minister doing? He is sitting on two reports that have been with him for 18 months while people are dying from cardiac disease. People are dying while the bureaucrats push paper and the Minister, subject to the monetarist pressures, pushes decisions further and further into the future. People are dying in the Principality because decisions are not being made about cardiac services.
I was a patient in hospital during August. As a patient, one is fairly captive when doctors, who are more likely to be supporters of the Conservative party than our party, tell people such as me what they see from the front line. The picture I received from two teaching hospitals in London is that there is a freezing of key medical posts and a reduction in beds, and physiotherapists tell me that because of the cut in study leave the quality of their personnel has suffered. Those who want to get on are forced to move to the private sector where they still have study leave. Physiotherapists also tell me that, because only two nurses are often left in large geriatric wards they are being forced to see physiotherapists more regularly for treatment to their backs and necks. That is one effect on nurses.
There is the same pattern in all hospitals and health authorities. That is what is happening in the real world. It

is far different from the illusion that the Conservative party seeks to portray. During the election campaign, the Prime Minister said that she would no more dismantle the Health Service than dismantle Britain's defences. But we see the reality in the Health Service around us. It is being slowly strangled by a lack of resources to meet the increased demand while the private sector—there was no criticism of the private sector in the Secretary of State's speech—is increasingly parasitic on the Health Service, in blood services and research, and by stripping the Health Service of trained nurses and other medical personnel.
Our people are still mightily and justifiably proud of our National Health Service. Its management costs, which have been so criticised by Conservative Members, are excellent by comparison with our major competitors. The Secretary of State will know of the report published in July on comparative management costs.
Monetarists in the Cabinet will gloat over public expenditure cuts and reductions in the Health Service, but the people in the field, those employed in the service, the patients and consumers of the service, will not gloat. They will see lengthening queues and a reduction in the quality of the Health Service.
At a time when the Government say that their aim is to reduce direct taxation I believe that to preserve and enhance the quality of our Health Service our people would be prepared to see even an increase in direct taxation. This is borne out by the polls. Unlike the Government, who have no commitment to a free and a National Health Service, as exemplified so tragically by the Prime Minister in her eye operation, it is the task of the Opposition to protect our Health Service, which was proudly established by the Labour party in that great postwar reforming Government. I believe that we shall have public opinion behind us because our people believe deeply in this working model of institutionalised compassion.

Mr. Deputy Speaker (Mr. Paul Dean): Before I call the next hon. Member, I should inform the House that the winding up speeches are expected to begin at 9 o'clock. Many hon. Members on both sides of the House who have waited a long time still hope to speak. I reiterate Mr. Speaker's appeal for short speeches.

Mr. Nigel Forman: I shall not follow the hon. Member for Swansea, East (Mr. Anderson) save to agree with his tribute to my hon. Friend the Member for High Peak (Mr. Hawkins) and extend that tribute to my hon. Friends the Members for Oxford, East (Mr. Norris) and for Warwickshire, North (Mr. Maude) for their excellent maiden speeches.
The main thing on which both sides of the House can agree is that we should preserve an efficient National Health Service available to all on the basis of need and largely free at the point of use. It is worth saying also that the Government's record in support of the Health Service over the past four years or so has been good. The figures are well known to the House, but I shall mention just two. There has been a 5·5 per cent. growth in hospital and community services over the past four years and a 4·75 per cent. growth in family practitioner services over the same period.
We now find ourselves in a cold economic climate in which the pressure will inevitably be on all forms of public


spending, vital though it may be in certain areas. Because of that, it will become that much more important for us to get the best possible value for money from the Health Service.
The hon. Member for Swansea, East mentioned the comparisons between the cost of administration of our Health Service and those elsewhere. The contrast that the hon. Gentleman made with America, where the cost of administration is about four times greater, is telling. That must have something to do with the fact that the Americans have a largely insurance-based system which is administratively much more expensive. My right hon. and hon. Friends on the Front Bench have done well to remember that in holding the line against a full-blooded insurance-based system in this country.
Because we support the Health Service and wish to see it succeed, we want to see greater efficiency in all areas of the service. Inevitably that means looking critically at manpower efficiency, because staff costs represent more than 70 per cent. of total NHS costs, and more than 70 per cent. of £15·5 billion is a lot of money in anybody's book. I therefore hope that the Minister will give me, when replying tonight or subsequently in correspondence, some answers to some points which bear on the question of efficiency. For example, why has the number of ambulance staff increased when apparently the number of patients carried each year has fallen? There may be good reasons for the increase, but that is the sort of issue we need to consider.

Mr. Boyes: rose——

Mr. Forman: I will not give way, in the interests of time.

Mr. Boyes: The hon. Gentleman should allow me to intervene, because what he said is not true.

Mr. Forman: If that is the case, no doubt the Minister will tell me later.
Why has the number of works and maintenance staff increased at a time when their workload has not noticeably grown? Why has the cost of the so-called hotel services risen in the longer stay hospitals? Why have the Government not had more success in controlling administrative costs in relation to medical costs? There has been some success in that direction, but why not more? Why, above all, has there not been more cost saving investment in the NHS, particularly in such things as energy conservation, which my right hon. Friend mentioned in his opening remarks when he pointed out that about £300 million were spent on energy in our hospitals? The examples I have mentioned are drawn from a Government document entitled "Health Care and its Costs" which drew our attention to them. I think that they are well founded and it is important that we should seek to put them right.
Even if the NHS were managed as efficiently as Sainsbury's there would still be inexorable increases in spending now and in the years ahead. We know the reasons for that—for example, the growth in the elderly proportion of the population and the improvements in medical technology, including scanners, gynaecological cytology, hip joint replacements, kidney transplants, bone marrow tranplants, and so on. Who is to say—in Parliament or anywhere else—that on the basis of the Hippocratic oath doctors cannot do those things if the

techniques are available? The difficulty is that there must be some reconciliation of the almost infinite demand for health care and the new forms of health care with the finite resources that are available, and it is there that the political and social difficulty resides.
Then there are the trends in the family practitioner services, which are largely demand determined and which can therefore have an adverse effect on the money available for hospital and community health spending, as we saw following the Chancellor's July package this year. I am particularly concerned about spending on drugs as prescribed by general practitioners. Some of the literature I have read tells me that about £1,156 million was spent on the GP drugs bill in 1981–32. Apparently drug spending represents about 10 per cent. of total NHS spending. I hope that my right hon. Friend and others will he in a position to give more news in the months ahead about, the progress that the Department is making in dealing with the problems of over-prescribing and the problems of expensive "me too" drugs. We have heard of examples—in dealing with, say, arthritis and other such matters—in that context.
I am not sure whether generic prescriptions are necessarily a total answer to that, but no doubt that too needs to be carried forward, as do the consultations, to which my right hon. Friend referred, between his Department and the pharmaceutical companies. The £9 million concession in real terms which the pharmaceutical companies made this year when they were asked to make a contribution to the Health Service was not adequate. If one looks at the size, scale and profitability of many of the companies, many of which are not based in this country but in Switzerland or the United States, one sees that in partnership with the NHS they could have made a better contribution. A step in that direction would be for the sponsorship role of the pharmaceutical companies to be switched to the Department of Trade and Industry and away from the DHSS. It is extremely difficult for the DHSS to act as a monitoring authority as well as a sponsor. There is often a severe conflict of interests, and I hope that the Department will make progress in overcoming it.
All these 'matters are examples of the inexorable pressures that lead to more NHS spending. I fear that the pressures may lead to a need for extra spending up to 1 per cent. or 2 per cent. a year in excess of the present level. In spite of the Government's generosity and good sense in this area, only 0.5 per cent. of extra Government money is going into the NHS each year. That will be the pattern over the coming years. Even when that is combined with the so-called efficiency savings of 0.5 per cent., there is still a disturbing gap left in funding.
I am not quite sure what the long-term policy should be for dealing with these problems, but good, sound management must have an important part to play, as is clear from the Griffiths report. Equally, some abridgement of clinical freedom will be necessary, especially in drug prescription and so-called clinical budgeting. Much more energy should be used on placing greater emphasis on the importance of health prevention and a positive health policy so that the NHS is truly a Health Service rather than a sick service. That, too, would help in the long-term.
I shall be interested to know what success the Department is having in taking the lead in promoting dietary changes among the general population on the lines urged by the National Advisory Committee on Nutrition Education. The committee will come up against strong and


entrenched interests, in this instance the interests of the food industry. It seems that if it is not the pharmaceutical industry it is the food industry. We must address ourselves to these matters in the cold economic climate in which we find ourselves. I hope that more positive steps will be taken to discourage smoking. I must declare an interest for I am a non-smoker. I should like to see a complete ban on smoking advertising and increased taxation levied on cigarettes.
Even if greater priority is given to public spending on the NHS and even if we have a recognition on the part of the public that it will be necessary to pay for this spending through the tax system—there is a good deal of evidence from the opinion polls and other sources that there is that recognition—it will be a good thing to concentrate our minds on getting the maximum value for money. Both sides of the House and both sides of the argument should be able to agree that that is common ground.
If there are Labour Members and others elsewhere who think that concern about the future of the Health Service is confined solely to those who occupy the Opposition Benches—it has become clear during the debate that that is not so—I think it right to observe that I have received many letters from constituents on this issue. Many of these letters have been written by Conservative voters and Conservative workers who care about the future of the NHS, who know a great deal about the subject at first hand and who are prepared to write to me to ask me to use what influence I have in acting on their behalf. In the interests of time, I shall not read out salutary excerpts from some of the correspondence. Perhaps it is sufficient for me to say that I can reassure my constituents that the Health Service is safe in the Government's hands provided that they take the necessary short-term and long-term steps at which I have hinted and to which my right hon. and hon. Friends have referred so powerfully in their contributions.

Mr. Doug Hoyle: First, I must declare my interest as a vice-president of ASTMS.
We had to wait a long tine to hear the voice of a Tory wet in this debate. I am pleased that the hon. Member for Carshalton and Wallington (Mr. Forman) was able to contribute to it, but sorry that he spoilt his speech at the end. I do not think that he really believes that the future of the Health Service is safe in the Secretary of State's hands.
The Secretary of State would have one believe that there is life after death. However, I do not want to be too hard on him. After all, he is only the robot who has to pull the switches for the Prime Minister—Mrs. Queue-jumper herself—who takes care of and supports the axeman, the Chancellor of the Exchequer. I was amazed when the Secretary of State had the impertinence to say that Labour Members were responsible for the lengthening of the hospital queues because of the Health Service dispute. The right hon. Gentleman was responsible for not giving Health Service workers a living wage. He bears all the responsibility for what has happened to the Health Service. If he had any decency at all, he would resign. Indeed, it would be far better if he went now. Perhaps we could then have the hon. Member for Carshalton and Wallington in his place.

Mr. Fowler: Who would we have in the hon. Gentleman's place?

Mr. Allan Rogers: My hon. Friend can speak without his master being here.

Mr. Hoyle: Of course I can.

Mr. Rogers: Like the Governor General, if he can be found.

Mr. Hoyle: He might return. Who knows? He has been kept for 24 hours with the allies. However, I do not want to be too distracted by the Secretary of State.
I should like to have the facts. The Government say that the cut is less than 1 per cent. In fact, it is not 1 per cent.; it is 1·8 per cent. based on the 8 months period also just to stand still, with an aging population and technical developments, the Health Service needs to grow at 1·2 to 1·5 per cent. Therefore, the real cuts are between 1·5 per cent. and 2·5 per cent. Those are the real cuts, and they will have an effect on patients.

Mr. Boyes: Will my hon. Friend give way?

Mr. Hoyle: No, I had better not give way at this stage, much as I should like to have the benefit of my hon. Friend's wisdom.

Mr. Boyes: Two per cent. is 20 per cent. in ambulances in my area.

Mr. Hoyle: I shall come to that matter in a moment.
I want to remind the Secretary of State about the research that was commissioned in his Department in July 1982, because we are hearing a lot of talk about efficiency. That report showed that the NHS was 25 per cent. more productive than the American health service and 10 per cent. better than the Canadian. So when we talk about efficiency, let me remind the Secretary of State that we have the most efficient Health Service in the world. The people who will suffer from these cuts are the patients. Moreover, in relation to GNP, this country spends far less than France, Australia, West Germany or the United States.
What we have not heard about is the way the Health Service is being used as a milch cow by the private sector. In the document "Health Service Management Charges for Private Patients", issued in March 1983, we find that the cost of using operating facilities in the NHS for 10 to 30 minutes is £29·50, and for more than 30 minutes £43·50. How can that be an economic charge? In pathology, a number of tests cost £5, in radiotherapy one treatment a day costs £11·50, and physiotherapy treatment and gymnastics cost £3·50. Those charges are ridiculously low, and in many instances they are not even collected. We know that when Mrs. Queue-jumper went in for her eye operation, if the hospital had not sent for NHS equipment, it could not have carried out the operation. As yet, I do not believe that that has been paid for. What is happening in the Health Service is a disgrace.
We must refer to what is happening on the ground to see that the cuts in Warrington are real. On almost his first day as Minister for Health, the hon. and learned Gentleman received a delegation from Warrington. He agreed that we were underfunded by about £4 million and did something about it. However, there will now be a cut in cash terms of £379,000. That will affect the people of Warrington. Of some 44 trainee nurses 39 will lose their


jobs. What effect will that have on the people? The waiting lists are lengthening and we are nowhere near meeting them.
My hon. Friend the Member for Houghton and Washington (Mr. Boyes) referred to the ambulance service. The service in Warrington is a disgrace. We have three motorways, so there is a high risk for the people in the town. In the daytime, five ambulances provide cover. Two of them spend much of the time bringing patients from Liverpool or Manchester or taking patients from Runcorn to Warrington. Another two are on call for outpatients. That leaves one ambulance available in the daytime for emergency cover in an area with three motorways. For a population of 180,000, there are only two locally based ambulances between 8 pm and 8 am. We had the same service when there was only one third of the present population in Warrington. In July there was an accident involving four people. The ambulance broke down and it was 20 minutes before the other ambulance arrived. However, Conservative Members talk of cutting that service, which is already underprovided for in Warrington.
The people in an area, such as Warrington, which has been underfunded for too long, are suffering. The Government's conduct is disgraceful. They keep saying that the Health Service is safe in their hands. It has never been and never will be. The best thing for the people to do is to continue to protest. I hope that an avalanche of letters is reaching the Government. They will not listen to us. The Opposition have repeated themselves time after time, as have our constituents, explaining what the conditions are like in the hospitals, what people have to put up with and how difficult it is to get in, but it all falls on deaf ears. One reason is that Conservative Members do not use the NHS. They use the private sector. Conservative Members neither know nor care about the NHS, and they are reduced to the level of the hon. Member for Birmingham, Edgbaston (Mrs. Knight), who talked about pilfering. The hon. Lady was quoting examples from six years ago. Such was the level of debate from Conservative Members. I do not know what source the hon. Lady was quoting, but it bore no relation to the Health Service.
The cuts should not take place. More money should be spent on the Health Service. The Government's priorities in the Health Service, as in many other areas, are wrong. They will become more and more unpopular because of the way in which they treat the NHS.

Mr. Charles Morrison: I have just about enough time to make the beginning and end of my speech and leave a large hole in the middle.
The amendment to the Opposition motion invites the House to congratulate the Government on what they have done for the Health Service. I am glad to do so. It is not far short of a miracle, during a world recession and at a time of economic stagnation, that there has been a considerable real increase in expenditure on the NHS. That is not to say that enough is being spent or enough is being done. The truth is that there will never be enough. There cannot be because resources are finite and the demand for health services is infinite. What is more, as we have heard several times in the debate, the demand is bound to grow because of the aging population and the introduction of modern technology.
I shall end my speech by giving two words of warning to the Government. First, they must not assume that vast savings can be made in the cost of administration or at the sharp end of the Health Service. I entirely applaud the Secretary of State's decision on the Griffiths report. I believe, however, that it will not produce many savings but simply a more efficient product.
Secondly, the Secretary of State must not allow the Chancellor of the Exchequer to think that as a result of the changes in management structure Health Service expenditure can be reduced so as to provide tax cuts. That would be extremely unpopular in my constituency and, no doubt, in many others.

Mr. Boyes: On a point of order, Mr. Speaker. May we have a ruling on whether an hon. Member speaking in this debate should declare an interest if he is in a private medical insurance scheme?

Mr. Speaker: I imagine that that sort of information is on the Register of Members' Interests. A great many hon. Members are in private schemes. I am not certain that that information has any relevance to the debate.

Mrs. Gwyneth Dunwoody: It is always interesting to hear maiden speeches. I am very pleased to welcome the three new hon. Members who have spoken in this debate. I particularly welcome the contribution of the hon. Member for High Peak (Mr. Hawkins) because he seems to have done an enormous amount of work on deputising services, a matter of considerable importance to the Health Service which I hope we shall have an opportunity to discuss in detail in the future. The quality of the care that the deputising services gives to patients should be a matter of concern to all hon. Members if we wish to improve any aspect of primary care.
I also found the contribution by the hon. Member for Oxford, East (Mr. Norris) extremely interesting, although I might disagree fundamentally on another occasion with his impression that all was well within his regional health authority. I have not heard a similar view expressed by members of local health authorities in Milton Keynes and other small towns in that part of Oxfordshire.
I am pleased to welcome the hon. Member for Warwickshire, North (Mr. Maude), although I must warn him that if he continues to make good jokes he will have a short parliamentary career.
The last general election was distinguished by the Conservative party suggesting that it was so committed to the Health Service and concerned about what was happening within it that during the Conservatives' period in office there had been an increase in the number of people involved in the service and a real increase in the amount of money given to it. Faint echoes of that suggestion have been heard today. There has been the ritual repetition of statistics which, frankly, I regard as "Fowler's mathematics". The Secretary of State seems to adopt a confetti attitude to statistics. He throws the figures up in the air hoping that with any luck they will not come down. There has been a deliberate attempt to suggest that, during the Conservatives' previous period of office, the Health Service was expanded and that what is now happening is merely a small clipping away of the amount of money involved.
When the Secretary of State spoke at the Tory party conference, he made the type of speech which earns politicians a bad name. He implied that the NHS could easily be made more efficient if the problems of overmanning were dealt with. He insisted that the NHS had too many administrators. Today hon. Members heard about the tail of administration. The Prime Minister likes to call such people "the bureaucrats".
The Secretary of State believes that somewhere lies a magic man management formula. His tenure of office has been distinguished by his having had at least four investigations into how the Health Service ought to run. Only this week we had yet another supposed management investigation which took eight months to conclude that the only people who are qualified to run the NHS are those who have no experience of relevant disciplines or the Civil Service.
The general idea among Conservative Members is that we need only to appoint a new chief executive—a new magic figure—and somehow the NHS will be turned into the equivalent of a nationalised industry. Why should the Health Service be treated as the Government treat nationalised industries? It could be that we are being asked to believe in the wisdom of appointing a new chief executive who will behave just like Mr. Ian MacGregor. Such a person would cut investment, close efficient units and sack as many staff as possible. The parallels with the mismanagement of the past few years are unmistakable.
The deeply held prejudices of the Tory party demand that the NHS be diminished and disoriented in the name of efficiency. That does not, of course, mean efficiency in staff management. Even the worst British manager should be able to work out that manpower targets should not be changed in the middle of a financial year. Nor are we dealing with efficiency in the use of resources as no finance officer who is worthy of that name can plan his cash flow or capital expenditure when every week brings a new instruction from on high which changes his accounting assumptions.
The new efficiency for which Tory Ministers aim consists entirely of an utterly unplanned closure of beds and wards and the unrelated freezing of vital posts such as junior hospital doctors. Moreover, that happens irrespective of the needs of the health regions.
We have also witnessed the beginnings of a direct attack on vital preventative services such as family planning clinics. The short-sightedness of that policy is so manifest that the resultant chaos has worried even Tory regional chairmen. With the exception of the chairman of the Mersey health authority—which is in my constituency—who ingloriously capitulated and accepted all of the cuts without a murmur, all chairmen of regional boards protested vigorously at the arbitrary and asinine quality of the Government's decisions. They knew that, far from improving the service, the latest round of imposed targets will mean worse patient care and staff relations.
The West Midlands regional health authority saved £11 million from its budget because it planned an expansion of badly needed posts in new hospitals and undermanned services. The Government instructed it to forget its plans to take on an extra 2,486 staff—who would have been paid for not by asking for extra cash but by savings which the authority had made. The Government then told the authority that it must reduce its staff by another 140.
The regional health authority's figures show that cuts as a result of the Lawson axe and earlier efficiency cuts have involved the loss of 3,626 jobs. That is not a 0·5 per cent. cut but a 4 per cent. cut. That is not the end of it. The effects of the ruthless squeeze on finance is being felt throughout the region.
It is useful to consider Birmingham, as both Ministers who are present should have some knowledge of what is going on there. Birmingham General Dispensary is a charitable organisation which has provided chiropody treatment for 4,000 patients. In 1983, it received a grant of £45,000 from the NHS and provided more than 21,000 treatments—almost entirely for elderly patients. Ministers know that provision of chiropody services is frequently the difference between keeping elderly people mobile and able to cope on their own in their own homes and having them admitted to extremely expensive geriatric beds. Now the dispensary has been told that its grant will not be renewed after March 1984, which will force closure upon it. The immediate and direct result is to add 4,000 elderly patients to waiting lists for chiropody treatment that are already nine to 12 months long. That area is represented by the Secretary of State. So much for the maintenance and improvement of standards of patient care.
Sometimes the decisions are Kafka-like in their nightmare quality. I was told today about a nurse who suffers from a prolapse and who has been waiting since April to receive treatment. She is off work because she cannot lift patients. Unfortunately for her, she works for an authority which has a policy of sacking staff who are off work for more than six months, so she now faces dismissal because she cannot receive treatment in a hospital that does not have enough staff to deal with the waiting list in order to enable her to return to nursing.
It has become painfully clear that the Tory plan for the revitalisation of the Health Service is a simple formula. During the past four years they have cut the finance available, not by small percentages but by a deliberate attack and by never giving the correct amount of money even to keep up with medical inflation. There has been a deliberate insistence that we must have privatisation irrespective of the real economic cost. That insistence went to the extent of instructing some regional authorities that they should not go ahead with plans for which they had set aside money, but that they should put all the work out to private tender. We have already been told that, in the case of areas such as Calderdale, even the local officials are convinced that the deliberate attack upon their decision is a political one, not an economic one.
However, the Secretary of State did not believe that the dismemberment of the Health Service was proceeding apace, so he decided to impose manpower cuts. It is important to realise that this is different from anything that has happened before. All the way through the reorganisation of the Health Service, Ministers told the House that we needed a much greater local input and that we needed people at the sharp end who could tell hospital authorities how money should be used in their region. However, they did not wish to carry that too far and have elected representatives, because they threw as many elected members as possible off the local representative bodies.
We were told that the point of this enormous, bruising and frightening reorganisation, which took nearly 18 months, and which made an enormous inroad into the


confidence of those working in the service, was that at least we would have much greater local involvement. The Secretary of State has decided after four years, and only two years after the reorganisation, that he will not allow the regional authorities to make their own decisions. He has already decided to call in the chairmen from time to time and to limit by cash means as many services as possible, but now he wishes to set up a central organising body to control all the cash limits and all the management targets. He even talks about central manpower targets. That is what he wants—to sit in the middle in London and to dictate throughout the Health Service what its future needs should be.
If we understand the extent of that change, we begin to see that much of the talk that we heard during the general election campaign was cant and hypocrisy. There was no intention to improve the National Health Service. There was a fear of confronting the service head-on, and a desire to make all the cuts by the back door. One means by which the Secretary of State believes that the new efficiency can be brought about is to invite any passing grocer who wishes to play a grown-up game of hospitals to come in and put any idea he wishes into operation. It is pathetic to see such management decision-making from a Secretary of State who should be responsible for a nationwide service.
Ministers intend to sell everything that is not nailed down and to asset-strip every piece of land from every hospital that can be put on the market. Every profit-making enterprise will go almost automatically to the private sector, and the staff will be left with an under-funded service with increasing numbers of patients to deal with.
The Government have handed out fiscal sweeteners, amounting to £4 million a year, to any employer who wants to take up private insurance for his employees. Were that money simply put back into the Health Service, we would at least believe that Ministers were serious. After all, staff are the Health Service. No one has yet invented a robot that will attend to a frightened child in the middle of the night or succour a mentally handicapped patient. If we believed that the Government were serious, we need only look at their financial targets to realise exactly how dishonest they have been with the electorate. They have issued guidelines which mean that for the next 10 years, taking account of the growing number of elderly and the increasing cost of technology, the NHS will suffer a cut of 0·7 per cent. in services every year. By 1988–89, if present trends continue, the Government will have cut £462 million from today's services.
Contrast that with the defence budget. Defence has been promised 3 per cent. more than the rate of inflation—£2,546 million if the present targets are retained. That is a very different set of priorities. The truth is that the NHS has suffered continuously. Last year it lost 10,867 staff before the Chancellor had his £140 million's worth of flesh.
Minister would like all those job losses to come from administration or ancillary staffs. They eternally say, "This is the end that can easily be cut," yet we know that the management costs of providing a comprehensive Health Service are lower in Great Britain than in almost any other developed country. In other words, the policies that they are putting into operation are based not on fact but on prejudice.
We can gauge the Government's view of the Health Service by looking at the way in which the Prime Minister behaves. She is keen on talking about leadership. Therefore, I shall put several questions to her, even though she has not honoured us with her presence this evening, although she was in the Chamber earlier. If she is so keen on giving a lead to the people, why did she not go for her own personal treatment to one of the best centres of excellence to be found anywhere in the world—[HON. MEMBERS: "Freedom of choice."] The Moorfields eye hospital has the best reputation of any comparable unit anywhere. Is it true that initially the Prime Minister was seen in an NHS hospital because she was an emergency? Will she also say whether her second operation depended on the fact that her private hospital had to borrow scalpels and clamps from the King Edward VII NHS hospital? The Government are so determined to run down the Health Service that they want to give people the impression that there is no need for those in the Cabinet to support the basic services.
It is useful to look at some of the things that are happening in the different regions. The Oxford region issues a questionnaire to be used by general practitioners to gain admittance for their patients to the large hospitals. It has suddenly sprouted a new sentence. It says:
If you are a member of a private health insurance scheme and wish to avail yourself of private patient facilities, please discuss this with the doctor in the outpatient clinic".
The member of the medical staff who raised that matter with me said that this was using those who believed in the NHS in a way that was utterly unacceptable. He said:
Those of us who support it will find ourselves advertising for the private sector. This is an intolerable position for us to be placed in".
We know that the manpower target factors were carefully aimed at a particular part of the year. Throughout the Health Service debate, and during the election, Ministers told us that the people who mattered in the NHS were not the dreadful ancillary workers who cleaned soiled linen and floors, but the doctors and nurses, but as soon as the manpower targets were published, it became obvious that the entire exercise was based on that point of the year in which there were already vacant posts. There were not only direct cuts, but, because of that factor, the cuts were far larger than anybody has been prepared to admit.
This Government, more than any other, know how to fiddle the figures. They were busy telling us that they had appointed so many extra nurses and had improved standards. They never said that a two and a half hour change had been made in the way that the nurses worked—a change negotiated by the previous Labour Government—which meant that simply changing the nurses' hours, added about 22,400 extra nurses to their figures. I do not know why the Government do not reduce the nurses' hours a great deal further. Without employing one extra nurse, they could double the numbers of people that they say have been employed in the Health Service. That would appeal to them.
The real efficiency improvements in the NHS should come from a number of simple, straightforward things. At long last, the Secretary of State said tonight that he was prepared to do something about the Acheson report. He must have had that report and the Harding report on his desk for at least two years. He must know that there is a great deal more to the reports than suggesting that


somehow or other, spending £3 million over three years can bring about an enormous difference in the quality of patient care.
The Secretary of State must know that the closure of many London hospitals and the direct loss of hospital beds is putting enormous pressure on primary care services, which are already unable to cope with the number of patients that they have. About 25 per cent. of Londoners do not have a general practitioner and the small provision of an extra grant for building improvements will not change that. The Secretary of State has done nothing to take up the fundamental suggestions in Acheson and he should be ashamed of pretending that by making a small gesture he will produce a revolutionary change.
There is one part of the NHS in which the Secretary of State could make an immediate, widely welcomed, saving. The drugs industry has a useful golden goose in the NHS. The industry does not need to sell its products, yet it spends 10 per cent. of its budget on advertising. It spends a great deal of money on hospitality, has a vested interest in promoting brand names and is an industry that the Public Accounts Committee found has been grossly overpaid for its products over the past few years. Will the Minister tonight tell us how much money the drug industry is prepared to give back? Will it be £25 million a year? At one point, the Secretary of State appeared to be saying that the repayment would be £25 million over six months, which is a different figure.
What will happen about generic substitutes? Is the Minister prepared to say that he will tell the Health Service that it can have generic substitutes in the future? They could save £117 million on the drugs bill immediately by moving towards the substitutes without restricting the clinical freedom of the doctors. He could make it easier for the patients to get much better value for money. However, we suspect that nothing like that will happen for a simple reason. The drug industry has an extremely powerful lobby in the Conservative party and it will make sure that none of its profits will be cut back.
Why is it that it has suddenly been enunciated that the primary health care services should, in effect be cash limited? Are general practices cash limited, or is it just an accident that Ministers propound the strange theory that because general practice has cost £100 million more than they expected, that extra money must come off the hospital sector? If that is what they are trying to do, why do they not have the decency to say that they are moving towards a fully salaried general practice service in which general practitioners are cash limited? Is it because Ministers are convinced that if they did that they would have to face a very powerful medical lobby? Indeed, it is a lobby that has not yet realised that the proposed changes will limit their clinical freedom far more than ever before.
Let us consider the suggestion of a management board and a board run by the Secretary of State. Who will give the powers to the general managers, who will now be in charge of the separate units? Who will overrule the clinical judgment of the medical establishment? Who will tell the nursing side that its background and views on the staffing of hospitals, wards or theatres do not matter, and that in future it will only be allowed a limited input into the decision-making process, because the general manager of the unit concerned will make the final decision?
There is a hospital in my constituency that is not even 20 years old. Less than 18 months ago Mersey region was so badly understaffed that nurses could not deal with the theatre lists. They told not only the administration but the regional hospital board that if staffing levels continued to be inadequate, they would be unable to provide a decent level of patient care. The administrators made it plain that they believed that the hospital was underfunded by about £2 million, yet less than a year later they face the loss of more than 20 nursing jobs and the closure of gynaecological and other vital beds. Before hon. Members start talking about hospital closures under the Labour Government, they should get one point clear. If a tatty old inadequate Victorian building is closed and replaced by neighbourhood or community or personal social services, that is very different from closing beds and wards in new hospitals.
At present, beds and wards are being closed, and new units and modern hospitals that have just been completed are being mothballed even though people need urgent health care. The reality is that Conservatives regard health care simply as something that requires very strange bookkeeping. To them it is not important that we can demonstrate the need for real improvements for patients. They are worried only about making an improvement in the economic side of the NHS. The hypocrisy of the Conservative party is best demonstrated in its attitude to the NHS. Throughout the general election Conservative candidates said that they were committed to the Health Service and would protect it and care about it, but they could not wait to attack its finances and its jobs, and to close units immediately afterwards. Such hypocrisy will not pass unnoticed and the people of this country will make them pay.

The Minister for Health (Mr. Kenneth Clarke): It is my pleasant task to congratulate three maiden speakers. It is an easy task because they made three excellent speeches. My hon. Friend the Member for Oxford, East (Mr. Norris) made a competent and eloquent speech. He chose the right subject because he is an experienced member of the east Berkshire district health authority. He will no doubt contribute frequently to our future debates on the Health Service.
My hon. Friend the Member for Warwickshire, North (Mr. Maude) succeeded in making a successful joke within the first two minutes of his first contribution in the House. As it was a joke about Leslie Huckfield, it united the House behind him. He will obviously carry large numbers of hon. Members behind him in his future contributions to our debates.
My hon. Friend the Member for High Peak (Mr. Hawkins) used his maiden speech to talk about a cause that has already become very much his own—the adequacy of deputising services in the NHS, and the service received by patients in some parts of the country when excessive use is made of such services. I am sure that the whole House appreciated the way in which he brought forward some of the problems with the quality of deputising services. It is largely in response to him that we have asked the family practitioner committees to report on how they are discharging their responsibilities in that area. The reports are almost to hand. We will bear my hon. Friend's


recommendations in mind when we move to the next step, which is the evaluation of the response from the committees and also from the public who use the services.
The debate saw a different maiden speech—not from a new Member, but from a new Leader of the Opposition. We all welcome him to his post. We are confident that we will hear that speech again and again. The peroration is much loved by us all but when applied to the NHS does not make a useful contribution to sustained debate outside the House.
One convention when replying to a debate is to say how excellent and useful a debate has been. Because of the contributions from the right hon. Member for Islwyn (Mr. Kinnock) and the hon. Member for Crewe and Nantwich (Mrs. Dunwoody), the debate has not been helpful. Unfortunately, a great deal of the debate across the floor has not addressed itself to the issues that concern the NHS. It has turned on the extraordinary claim that the background to the debate is intended cuts, past cuts and future cuts, and that the Government are somehow reducing expenditure and services in the NHS as a whole.
We do not wish to hear any unparliamentary language. On previous occasions I may have sailed near to that by describing that approach as the "big lie" technique. Today the right hon. Gentleman actually accused the Government of premeditated falsehood and claimed that we were perpetuating that falsehood. We will not respond in kind. We make no attack upon the sincerity of the right hon. Gentleman. His falsehoods were unpremeditated and unintended because he had not carried out enough research into the subject on which he chose to embark. He talked about reductions in the standards of care between 1979 and the present time. My right hon. Friend the Secretary of State in his speech, which immediately followed that of the right hon. Gentleman, gave details of the increased provision of patient care—category by category—that has taken place while we have been in office.
The right hon. Gentleman spoke about the lengthening waiting lists, which he had the nerve to say have grown while the Conservative Government have been in office. The record-breaking level of waiting lists was reached in March 1979. when the figure stood at 752,000. In March 1983 the figure had been reduced to 726,000. What determines waiting lists is, in part, the pace of medical advance. There are all those who are now able to wait for hip replacement operations that were not possible a few years ago. Waiting lists are always with us, but contrary to assertions, they have been declining and continue to decline, except during periods of industrial action backed by the Labour party.
The underlying fallacy in the Labour party's claim is the continued assertion that we have made cuts in spending over the past four years. Many argue about the use of statistics, and I agree with all those hon. Members who say that all that the public want to hear about are patients—that was a word that the hon. Member for Crewe and Nantwich mentioned, I think, only once in half an hour—and that they do not want to get lost in the miasma of statistics.
There are four straightforward statistics which no hon. Member has been able to challenge in this debate or any other. Cash spending has doubled since June 1979. The economic cost to the country, for which purpose one makes a comparison with the retail price index, has increased by 17·5 per cent. If one makes an allowance for the increased cost of medical services there has been a

planned growth in service of 7·5 per cent. and capital expenditure is up 14 per cent. It requires a curious use of the English language to continue to use the word "cut" to describe any of that financial provision over the past four years.
There have been even more fanciful attacks on manpower. The hon. Member for Bradford, West (Mr. Madden), in a speech which, although I welcome his return, made me think at one point that he had brought his soap box with him, got carried away when talking about sacked doctors and nurses. I have not yet met a doctor or a nurse who has been sacked as a result of any measures taken by the Government. I shall meet one if the hon. Gentleman can find one. He would not give way during his speech when he saw me trying to rise and challenge him to produce any such individual.
The hon. Member for Fife, Central (Mr. Hamilton) launched in with figures of 20,000 unemployed nurses and 3,000 unemployed doctors. I can only say that those figures are the highest that I have yet heard in the usual fictional accounts that are given about the number of unemployed professionals in Britain and I do not have the slightest idea of his source. The best estimate of unemployed doctors that we have is about 1,000, most of whom are employed for short periods between jobs. If we did not have that many registered unemployed doctors people would be complaining about a shortage because there would be no mobility to enable movement from job to job.

Mrs. Dunwoody: Why is it that the British Medical Association's junior hospital doctors committee has estimated that on the basis of its survey there are 3,500 unemployed?

Mr. Clarke: I look forward to the BMA junior hospital doctors committee producing the slightest evidence for that figure which I have heard it use. The best estimate that we can make is the one that I have given. Any occupation is bound to have a number of unemployed at any set time.
The right hon. Member for Plymouth, Devonport (Dr. Owen) tried, on behalf of the Social Democrats, to focus without too many statistics on the issue that we should be looking at—the level of provision, not cut provision, and how it matches demand. At least he dismissed the Labour party's case. He said that it would be a fool who sought to deny that there had been an increase in resources between 1979 and 1983 and that resources had failed to keep up with demographic demand. I share that judgment with him; and those to whom the description attaches should wear the cap that fits them.
The right hon. Gentleman went on to concentrate not on challenging the Government's record before the election, which cannot be attacked on the grounds assumed by the Labour party, but on what had occurred since the election which, he tried to claim, showed some change of course by the Government incompatible with what we then said. First, he talked about manpower targets. I shall dismiss one or two of the other unpremeditated falsehoods. It is been said that we made no announcement before the election, but we did that back in July 1982. The claim has just been made that we changed the manpower targets in mid-year, but we did no such thing. We produced the first indicative targets in July because we did not then have the figures that were supposed to be forthcoming and we have not changed them.
The right hon. Gentleman said that he accepted that savings had to be made in some staff posts and that there were savings to be made in the Health Service. He claimed that the savings should be part of a transfer of staff from those places where they could be saved to where they could be better deployed. He re-attacked our targets, claiming that they are somehow affecting key posts in areas catering for the elderly and other priority groups. That is not the case. While we were carrying out the manpower target exercise this year and negotiating with health authorities, we discovered from their returns and their estimates before the targets were set that although most health authorities were fairly level spenders they were proposing to increase their staff by about 7,000 primarily in administrative, clerical and work areas, not in the frontline areas. In negotiating with the regions—this is now being carried through to the districts—we aimed to re-examine the system to ascertain the scope for the elimination of unnecessary posts so that money could be saved and devoted to developments, new hospitals, wards and services.
We concluded that this year's developments would save a little under 5,000 posts in a service that employs 820,000 people. Our examination showed also that better efficiency in manpower use—this will be achieved by authorities—would produce £40 million which could be spent elsewhere in the service on development by those health authorities.

Mr. Pavitt: rose——

Mr. Clarke: I shall not give way; a number of hon. Members failed to give way to me.
The right hon. Gentleman and others referred to the Acheson report and the statement by the Secretary of State about improving services in inner cities. No one has challenged the desirability of improving the level of primary care in inner cities. We have described the way in which money will be expended on nurse training, group practice and grants for the improvement of substandard premises in which doctors must operate.

Mr. Andrew F. Bennett: Where will the money come from?

Mr. Clarke: I am helpfully reminded of the question. This money is new. It is not being taken from the budgets of the health authorities or the family practitioner service. We made provision for this money in this year's White Paper. Earlier this year, we announced an increase of £3 million. The Secretary of State announced that the full programme would cost £9 million. I am sorry that the hon. Gentleman does not seem pleased with his answer that we are devoting more money to primary inner city care.
The right hon. Member for Devonport asked me why we were not expanding the joint finance system which is useful in promoting co-operation between health and local authorities and in promoting a caring community policy. I am sorry that there was no announcement today of more money for joint finance. Since the Government came into power, joint finance has increased from £31 million in 1978–79 to £90 million this year—an increase in real terms of no less than 80 per cent. in that desirable part of the service.
The right hon. Member for Devonport and others talked about the effect of the July measures on overall

expenditure this year. Those who say that there is a contrast between what we are doing and spending now and what we did and spent when we made our speeches during the election are using a false premise and only a part of the statistics. The right hon. Gentleman tried to demonstrate that this year there was a 0·2 per cent. reduction in real terms in the budget of the NHS. I point out that he was taking only the figures for the health authorities providing the hospital services; he was ignoring the general practitioners, the family practitioners and total spending on the NHS.
Our position is unchanged from what the Prime Minister said at Edinburgh and during the Election. The July measures have had a neutral effect on spending on the NHS as a whole. They keep us at the planned levels, of which we were proud during the Election. The reduction in the cash limit of programmes took £89 million from hospital health authorities' budgets. Forecasts for expenditure on the family practitioner services showed an increase of £108 million. Those who wish to criticise the increased spending on the family practitioner services per se are making a mistake. The House knows that the family doctor system in this country is one of the better features of the NHS vis-à-vis services provided in other countries. Extra expenditure upon it is of benefit to the National Health Service but it has to be paid for like any other expenditure and has to be accommodated between planned levels and what the economy can afford.
There are those who would query whether over the years the balance of spending——

Mr. Clement Freud: rose——

Mr. Clarke: I am sorry that the hon. Gentleman has not been here throughout the debate, but it is too late to give way—between the hospital services and the family practitioner services—they have sometimes taken more money from the hospital services—has always been good.
In so far as the increased expenditure reflects an increase in the drugs bill, I can assure the hon. Lady for Crewe and Nantwich and those who raised the subject, that we are no more sparing the drugs bill from the search for economies to release resources for patient care than any other area. In so far as this year's increased expenditure was partly the result of the drugs bill, for the remaining part of the financial year we have already obtained £25 million from the planned drugs bill by freezing prices until the end of this year.
We are negotiating reductions in the anticipated drugs bill with the pharmaceutical industry by renegotiating that system of payment for drugs that the Labour party introduced in the late 70s when the right hon. Member for Devonport, who mentioned the point, was Minister for Health.
I assure those who are worried about the drugs bill that we will make savings, but when the hon. Member for Crewe and Nantwich says that by generic substitution alone we can save £170 million, I would point out that the best estimate of the total profitability of the industry from the National Health Service is £250 million. On top of all the other things that she believes that she can obtain from the drugs bill, she will put 70,000 people out of work and turn away a great deal of inward investment—[Interruption]—in a valuable industry. Her estimate of


potential savings from generic substitution, at which we are looking, is a grotesque exaggeration compared with any estimates that we have.

Mr. Pavitt: rose——

Mr. Clarke: The best illustration of the impact of what we have done this year was given by the two maiden speakers with experience of health authorities. My hon. Friend the Member for Oxford, East (Mr. Norris), the vice-chairman of east Berkshire health authority, gave an incontrovertible description of the effect upon his authority. He said that the 51 staff post cuts being asked for will have no effect upon his authority and the cash cuts would also have no effect because the authority did not reach the level of estimated underspend.
I assure my hon. Friend, and others who are worried, that the suggestion that manpower targets might be set for different categories of staff does not arise. We did not prescribe any cuts for doctors or nurses or any other group of staff. District health authorities are left entirely free to decide where unnecessary staff posts can be saved. There is no injunction upon them to reduce staff posts in any particular area.
My hon. Friend the Member for Warwickshire, North and my hon. Friend the Member for Oxford, East said that one of the difficulties in estimating the effects of our manpower target this year is the number of authorities who could not say how many people they employed. The target exercise enabled them to concentrate on searching for efficiency and that will benefit the authorities.
The record must be set against the rising demand for services. My hon. Friends the Members for Eastleigh (Sir D. Price) for Devizes (Mr. Morrison) and for Birmingham, Edgbaston (Mrs. Knight) in the most informed speeches on the Health Service all acknowledged—[Interruption.]—the rising demand for health care and the potential danger, as my hon. Friend the Member for Eastleigh said, of expectations of health care going ahead of resources as they always have done since 1948. The problem to which the debate should address itself is how to get as near to those expectations as one can from the resources one can reasonably expect the economy and the taxpayer to provide.
The answer, as I understand it from the Opposition, is that the taxpayer should pay more for the service that he already gets or will get. The taxpayer already has that pleasure because the priority that the Government are giving to the National Health Service and the cost upon the tax he pays for the National Health Service has steadily increased since we came to power.
When we came to office in 1979 the cost of the National Health Service per head of the population was £143. In 1983 it has risen to £268. The proportion of the gross domestic product had risen from 4·7 per cent. expenditure on the Health Service that the Labour Government left us when their concern was a little less sharp than it is now to the present 5·5 per cent.
The right hon. Member for Devonport did not try out in the House today the only way in which outside he tried to address this problem. I have seen reports in The Times of an article in which he floated the idea of a new local health tax to finance—presumably over and above general taxation—extra health care in this country. That tax might be a little more popular than rates, but nevertheless it would be an addition to the total level of local taxation,

whether levied by rates or income tax. The experience of people being asked to take added burdens for health is not always as good as it might be in general. The experience of raising prescription charges never brings out in the Opposition a sudden desire to see more revenue spent on health. But such a tax would also be a new impost on the economy of this country. Whatever it was called and however it was raised, it would be new taxation and would inevitably have an impact on the proportion of GDP being spent on health care and or the amount left available for economic development.
I remind the right hon. Gentleman of his thoughts in November 1975 when he was Minister of State. He did not look for new taxation as a way out of the problem. During the period of office of which he was so proud, he said:
It will be difficult to persuade and to explain to people why we need to cut back in some of our social services, which most of us hold very dear, in order to increase industrial development and earn our living in the markets of the world."—[Official Report, 21 November 1975; Vol. 901, c. 445.]
I am not surprised that the right hon. Gentleman said that because he was in the middle of a pay dispute with junior doctors caused by pay policy. He was trying to rein back his then Secretary of State who was devoting all his efforts to trying to phase out pay beds. They were on the eve of the 1976 clash when his Government had to cut back capital spending on the National Health Service to a degree which we never have.
We believe that our record in making demands on the taxpayer and spending on the service is a good one, but these extra demands can be avoided and are not a real need if on top of increased spending we can achieve ever better value for money and ever more efficiency and performance for the benefit of the patient, who will derive more care if we can reduce to a minimum the cost of administration, laundries, support and so on. On that point I do not understand how the Opposition face up to the issues—if they face up to the real issues at all. The problem of efficiency is not new. The theme has been recurrent during debates on the Health Service in recent years but at the moment the Labour party appears to have abdicated all responsibility for contributing to debate and has resisted any attempts we make to change matters and to improve the performance of the Health Service.
We are criticised for talking about the administrative tail of the Health Service. I can find quotations from Lord Ennals when he was Secretary of State acknowledging that there was too much administration in the service and pledging himself to try to reduce it. He actually started what he called a management cost exercise. The difference between what they did and what we are doing is that they were unsuccessful in restraining the administration of the service. When they were in office the number of administrative and clerical staff rose from 82,700 in 1974 to 100,300 in 1979, yet their Ministers were asserting that they wished to cut down unnecessary administration
Since then we have abolished a whole tier of authorities so as to cut down unnecessary waste and we have embarked on our manpower targets policy so as to release £40 million this year, concentrating in particular on administration. We have produced the Griffiths report, which also addresses itself to the style of management and the performance of administration. There are some excellent managers and administrators in the service. We


require the right structure of administration to get the best out of them so that they can make their contribution to decision-making and patient care.
The Griffiths report has had a good reception from those in the service, particularly consultants and administrators, who see the need for change. Indeed, as the Griffiths report team went round it received hardly any representations from people saying that nothing needed to be done to the present structure.

Mr. Pavitt: What about the Royal College of Nursing?

Mr. Clarke: The Guardian, which is not renowned for giving my right hon. Friend and myself an easy ride on Health Service projects, said in a leader about what it called "the Sainsbury prescription":
In short, this report deserves to be taken seriously as a contribution to the debate about the National Health Service. It would ill serve either the NHS as dedicated employers or its patients to fail to take advantage of what can be learnt from better management techniques or to fail to ask why the same operation may take three times as long in parts of London as in Kingston or twice as long as in Chelmsford. The medical professions are better able to make explicit choices as a result of such information and management; so much the better for clinical freedom, too.
There has been that and much other serious editorial comment, yet what we got from the hon. Member for Crewe and Nantwich were snide jokes about grocers and a mish-mash of an analysis of the Griffiths report. She did not even address herself to the redistribution of resources among different parts of the country.
We are following the principles of the Resource Allocation Working Party, the RAWP system, set up by the Labour Government. The difference is that we are following it through consistently and are looking for the biggest savings in those parts of the country which are plainly comparatively over-resourced and where the biggest savings can be made.
But what do Labour Members do? They support the activities of Brent district health authority in its resistance to further savings this year. That authority is 25 per cent. over the target laid down for spending by the Labour Party's own RAWP system. It is one of the most high-spending district health authorities in Britain. When it had its key meeting earlier this year it was informed by its treasurer that it was heading for an underspend of about £500,000 this year, but what was its reaction to the suggestion that £250,000 might go back to the region? The authority then embarked on a spending programme which included refurbishing the staff kitchens and new equipment for the telephone switchboard, all in an attempt to get through the cash limits. Its levels of financial control are probably not good enough to enable it to spend the money quickly enough to do that.
That gets support from the Labour Party, yet that money, if spent in that way, will be spent at the expense of other parts of the region, such as Luton and Dunstable, and other parts of the country, such as Warrington, which on any RAWP formula are underfinanced. I will not go further into matters which the Labour Party resists whenever——

Mr. Boyes: rose——

Mr. Clarke: I cannot see what is wrong with testing the costs of laundry, cleaning and catering if one can

maintain the same standard of care by laying down the right levels of care and allowing the savings to come back to the patients.
Calderdale has been cited throughout the debate and the right hon. Member for Islwyn said that the spending of £2 million on a new hospital in Calderdale was justified to make a saving of £18,000 each year—£2 million out of a capital programme which could otherwise be spent on hospitals—all to protect Calderdale against having to put its costs out to tender.
My hon. Friend the Member for Carshalton and Wallington (Mr. Forman) reaffirmed the Government's commitment to the NHS. I too, reaffirm that commitment on behalf of the Government. We propose to change and improve the Health Service whereas the right hon. Member for Islwyn is wedded to 1948 and Nye Bevan. He resists change in a way that is entirely contrary to the true interests of the NHS.

Question put, That the original words stand part of the Question:—

The House divided: Ayes 205, Noes 338.

Division No. 52]
[10 pm


AYES


Abse, Leo
Dixon, Donald


Adams, Allen (Paisley N)
Dobson, Frank


Alton, David
Dormand, Jack


Anderson, Donald
Douglas, Dick


Archer, Rt Hon Peter
Dubs, Alfred


Atkinson, N. (Tottenham)
Duffy, A. E. P.


Bagier, Gordon A. T.
Dunwoody, Hon Mrs G.


Banks, Tony (Newham NW)
Eadie, Alex


Barron, Kevin
Eastham, Ken


Beckett, Mrs Margaret
Edwards, R. (W'hampt'n SE)


Beith, A. J.
Ellis, Raymond


Bell, Stuart
Evans, Ioan (Cynon Valley)


Bennett, A. (Dent'n &amp; Red'sh)
Evans, John (St. Helens N)


Bermingham, Gerald
Ewing, Harry


Bidwell, Sydney
Fatchett, Derek


Blair, Anthony
Faulds, Andrew


Boyes, Roland
Field, Frank (Birkenhead)


Bray, Dr Jeremy
Fields, T. (L'pool Broad Gn)


Brown, Gordon (D'f'mline E)
Fisher, Mark


Brown, Hugh D. (Provan)
Flannery, Martin


Brown, N. (N'c'tle-u-Tyne E)
Foot, Rt Hon Michael


Brown, Ron (E'burgh, Leith)
Forrester, John


Bruce, Malcolm
Foulkes, George


Caborn, Richard
Fraser, J. (Norwood)


Callaghan, Rt Hon J.
Freeson, Rt Hon Reginald


Callaghan, Jim (Heyw'd &amp; M)
Freud, Clement


Campbell, Ian
Garrett, W. E.


Canavan, Dennis
George, Bruce


Carlile, Alexander (Montg'y)
Godman, Dr Norman


Cartwright, John
Golding, John


Clark, Dr David (S Shields)
Gould, Bryan


Clarke, Thomas
Gourlay, Harry


Clay, Robert
Hamilton, James (M'well N)


Cocks, Rt Hon M. (Bristol S.)
Hamilton, W. W. (Central Fife)


Cohen, Harry
Hardy, Peter


Coleman, Donald
Harman, Ms Harriet


Concannon, Rt Hon J. D.
Harrison, Rt Hon Walter


Cook, Robin F. (Livingston)
Hart, Rt Hon Dame Judith


Corbett, Robin
Hattersley, Rt Hon Roy


Corbyn, Jeremy
Healey, Rt Hon Denis


Cowans, Harry
Holland, Stuart (Vauxhall)


Craigen, J. M.
Home Robertson, John


Crowther, Stan
Howell, Rt Hon D. (S'heath)


Cunliffe, Lawrence
Howells, Geraint


Cunningham, Dr John
Hoyle, Douglas


Dalyell, Tam
Hughes, Mark (Durham)


Davies, Rt Hon Denzil (L'lli)
Hughes, Robert (Aberdeen N)


Davies, Ronald (Caerphilly)
Hughes, Roy (Newport East)


Davis, Terry (B'ham, H'ge H'l)
Hughes, Sean (Knowsley S)


Deakins, Eric
Hughes, Simon (Southwark)


Dewar, Donald
Jenkins, Rt Hon Roy (Hillh'd)






John, Brynmor
Powell, Raymond (Ogmore)


Jones, Barry (Alyn &amp; Deeside)
Prescott, John


Kaufman, Rt Hon Gerald
Radice, Giles


Kennedy, Charles
Randall, Stuart


Kilfedder, James A.
Redmond, M.


Kilroy-Silk, Robert
Richardson, Ms Jo


Kinnock, Rt Hon Neil
Roberts, Ernest (Hackney N)


Lambie, David
Robertson, George


Lamond, James
Robinson, G. (Coventry NW)


Leadbitter, Ted
Rogers, Allan


Leighton, Ronald
Rooker, J. W.


Lewis, Ron (Carlisle)
Ross, Ernest (Dundee W)


Lewis, Terence (Worsley)
Ross, Stephen (Isle of Wight)


Litherland, Robert
Rowlands, Ted


Lloyd, Tony (Stretford)
Ryman, John


Lofthouse, Geoffrey
Sedgemore, Brian


Loyden, Edward
Sheerman, Barry


McCartney, Hugh
Sheldon, Rt Hon R.


McDonald, Dr Oonagh
Shore, Rt Hon Peter


McGuire, Michael
Silkin, Rt Hon J.


McKay, Allen (Penistone)
Skinner, Dennis


McKelvey, William
Smith, C. (Isl'ton S &amp; F'bury)


Mackenzie, Rt Hon Gregor
Smith, Rt Hon J. (M'kl'ds E)


Maclennan, Robert
Snape, Peter


McNamara, Kevin
Spearing, Nigel


McTaggart, Robert
Steel, Rt Hon David


McWilliam, John
Stewart, Rt Hon D. (W Isles)


Madden, Max
Stott, Roger


Marek, Dr John
Strang, Gavin


Marshall, David (Shettleston)
Straw, Jack


Martin, Michael
Thompson, J. (Wansbeck)


Mason, Rt Hon Roy
Thorne, Stan (Preston)


Maxton, John
Tinn, James


Meacher, Michael
Varley, Rt Hon Eric G.


Meadowcroft, Michael
Wainwright, R.


Michie, William
Walden, George


Mikardo, Ian
Wallace, James


Millan, Rt Hon Bruce
Wardell, Gareth (Gower)


Miller, Dr M. S. (E Kilbride)
Wareing, Robert


Morris, Rt Hon A. (W'shawe)
Weetch, Ken


Morris, Rt Hon J. (Aberavon)
Welsh, Michael


Nellist, David
White, James


Oakes, Rt Hon Gordon
Wigley, Dafydd


O'Brien, William
Williams, Rt Hon A.


O'Neill, Martin
Wilson, Gordon


Orme, Rt Hon Stanley
Winnick, David


Owen, Rt Hon Dr David
Woodall, Alec


Park, George
Wrigglesworth, Ian


Parry, Robert
Young, David (Bolton SE)


Patchett, Terry



Pavitt, Laurie
Tellers for the Ayes:


Pendry, Tom
Mr. Austin Mitchell and Mr. Norman Hogg.


Penhaligon, David



Pike, Peter





NOES


Adley, Robert
Biffen, Rt Hon John


Alexander, Richard
Biggs-Davison, Sir John


Alison, Rt Hon Michael
Blaker, Rt Hon Sir Peter


Amery, Rt Hon Julian
Body, Richard


Amess, David
Bonsor, Sir Nicholas


Ancram, Michael
Bottomley, Peter


Arnold, Tom
Bowden, A. (Brighton K'to'n)


Ashby, David
Bowden, Gerald (Dulwich)


Aspinwall, Jack
Boyson, Dr Rhodes


Atkins, Rt Hon Sir H.
Braine, Sir Bernard


Atkins, Robert (South Ribble)
Brandon-Bravo, Martin


Atkinson, David (B'm'th E)
Bright, Graham


Baker, Kenneth (Mole Valley)
Brinton, Tim


Baker, Nicholas (N Dorset)
Brittan, Rt Hon Leon


Baldry, Anthony
Brooke, Hon Peter


Banks, Robert (Harrogate)
Brown, M. (Brigg &amp; Cl'thpes)


Batiste, Spencer
Browne, John


Bellingham, Henry
Bruinvels, Peter


Bendall, Vivian
Bryan, Sir Paul


Bennett, Sir Frederic (T'bay)
Buchanan-Smith, Rt Hon A.


Benyon, William
Buck, Sir Antony


Berry, Sir Anthony
Budgen, Nick


Best, Keith
Bulmer, Esmond


Bevan, David Gilroy
Burt, Alistair





Butcher, John
Hayes, J.


Butler, Hon Adam
Hayhoe, Barney


Butterfill, John
Hayward, Robert


Carlisle, Kenneth (Lincoln)
Heathcoat-Amory, David


Carttiss, Michael
Heddle, John


Chalker, Mrs Lynda
Henderson, Barry


Channon, Rt Hon Paul
Hickmet, Richard


Chapman, Sydney
Hicks, Robert


Chope, Christopher
Higgins, Rt Hon Terence L.


Churchill, W. S.
Hill, James


Clark, Hon A. (Plym'th S'n)
Hind, Kenneth


Clark, Dr Michael (Rochford)
Hirst, Michael


Clark, Sir W. (Croydon S)
Hogg, Hon Douglas (Gr'th'm)


Clarke Kenneth (Rushcliffe)
Holland, Sir Philip (Gedling)


Clegg, Sir Walter
Holt, Richard


Colvin, Michael
Hooson, Tom


Coombs, Simon
Howard, Michael


Cope, John
Howarth, Alan (Stratf'd-on-A)


Cormack, Patrick
Howarth, Gerald (Cannock)


Couchman, James
Howell, Rt Hon D. (G'ldford)


Critchley, Julian
Hubbard-Miles, Peter


Crouch, David
Hunt, David (Wirral)


Currie, Mrs Edwina
Hunt, John (Ravensbourne)


Dickens, Geoffrey
Hunter, Andrew


Dicks, T.
Hurd, Rt Hon Douglas


Dorrell, Stephen
Irving, Charles


Douglas-Hamilton, Lord J.
Jackson, Robert


Dover, Denshore
Jenkin, Rt Hon Patrick


du Cann, Rt Hon Edward
Jessel, Toby


Dunn, Robert
Johnson-Smith, Sir Geoffrey


Dykes, Hugh
Jones, Gwilym (Cardiff N)


Eggar, Tim
Jones, Robert (W Herts)


Emery, Sir Peter
Jopling, Rt Hon Michael


Evennett, David
Joseph, Rt Hon Sir Keith


Eyre, Reginald
Kershaw, Sir Anthony


Fairbairn, Nicholas
Key, Robert


Fallon, Michael
King, Roger (B'ham N'field)


Farr, John
King, Rt Hon Tom


Favell, Anthony
Knight, Gregory (Derby N)


Fenner, Mrs Peggy
Knight, Mrs Jill (Edgbaston)


Finsberg, Geoffrey
Knowles, Michael


Fletcher, Alexander
Knox, David


Fookes, Miss Janet
Lang, Ian


Forman, Nigel
Latham, Michael


Forsyth, Michael (Stirling)
Lawler, Geoffrey


Fowler, Rt Hon Norman
Lawrence, Ivan


Fox, Marcus
Lawson, Rt Hon Nigel


Franks, Cecil
Lee, John (Pendle)


Fraser, Rt Hon Sir Hugh
Leigh, Edward (Gainsbor'gh)


Fraser, Peter (Angus East)
Lennox-Boyd, Hon Mark


Freeman, Roger
Lester, Jim


Fry, Peter
Lewis, Sir Kenneth (Stamf'd)


Gale, Roger
Lightbown, David


Galley, Roy
Lilley, Peter


Gardiner, George (Reigate)
Lloyd, Ian (Havant)


Gardner, Sir Edward (Fylde)
Lloyd, Peter, (Fareham)


Garel-Jones, Tristan
Lord, Michael


Gilmour, Rt Hon Sir Ian
Lyell, Nicholas


Glyn, Dr Alan
McCurley, Mrs Anna


Goodlad, Alastair
Macfarlane, Neil


Gorst, John
MacGregor, John


Gow, Ian
MacKay, Andrew (Berkshire)


Gower, Sir Raymond
MacKay, John (Argyll &amp; Bute)


Grant, Sir Anthony
Maclean, David John.


Gregory, Conal
Macmillan, Rt Hon M.


Griffiths, E. (B'y St Edm'ds)
McNair-Wilson, M. (N'bury)


Griffiths, Peter (Portsm'th N)
McNair-Wilson, P. (New F'st)


Grist, Ian
McQuarrie, Albert


Ground, Patrick
Madel, David


Grylls, Michael
Major, John


Gummer, John Selwyn
Malins, Humfrey


Hamilton, Hon A. (Epsom)
Malone, Gerald


Hamilton, Neil (Tatton)
Maples, John


Hampson, Dr Keith
Marland, Paul


Hanley, Jeremy
Maude, Francis


Hannam,John
Mawhinney, Dr Brian


Hargreaves, Kenneth
Maxwell-Hyslop, Robin


Harvey, Robert
Mayhew, Sir Patrick


Haselhurst, Alan
Mellor, David


Hawkins, C. (High Peak)
Merchant, Piers






Miller, Hal (B'grove)
Soames, Hon Nicholas


Mills, Iain (Meriden)
Speed, Keith


Mills, Sir Peter (West Devon)
Speller, Tony


Moate, Roger
Spence, John


Monro, Sir Hector
Spencer, D.


Montgomery, Fergus
Spicer, Jim (W Dorset)


Moore, John
Spicer, Michael (S Worcs)


Morris, M. (N'hampton, S)
Squire, Robin


Morrison, Hon C. (Devizes)
Stanbrook, Ivor


Moynihan, Hon C.
Stanley, John


Murphy, Christopher
Steen, Anthony


Neale, Gerrard
Stern, Michael


Needham, Richard
Stevens, Lewis (Nuneaton)


Neubert, Michael
Stevens, Martin (Fulham)


Newton, Tony
Stewart, Allan (Eastwood)


Nicholls, Patrick
Stewart, Andrew (Sherwood)


Norris, Steven
Stewart, Ian (N Hertf'dshire)


Onslow, Cranley
Stokes, John


Oppenheim, Philip
Stradling Thomas, J.


Oppenheim, Rt Hon Mrs S.
Sumberg, David


Osborn, Sir John
Tapsell, Peter


Ottaway, Richard
Taylor, John (Solihull)


Page, Richard (Herts SW)
Taylor, Teddy (S'end E)


Parris, Matthew
Tebbit, Rt Hon Norman


Patten, Christopher (Bath)
Terlezki, Stefan


Patten, John (Oxford)
Thatcher, Rt Hon Mrs M.


Pattie, Geoffrey
Thomas, Rt Hon Peter


Peacock, Mrs Elizabeth
Thompson, Donald (Calder V)


Percival, Rt Hon Sir Ian
Thompson, Patrick (N'ich N)


Pink, R. Bonner
Thorne, Neil (Ilford S)


Porter, Barry
Thornton, Malcolm


Powell, William (Corby)
Thurnham, Peter


Powley, John
Townend, John (Bridlington)


Prentice, Rt Hon Reg
Townsend, Cyril D. (B'heath)


Price, Sir David
Tracey, Richard


Proctor, K. Harvey
Trippier, David


Raffan, Keith
Twinn, Dr Ian


Raison, Rt Hon Timothy
van Straubenzee, Sir W.


Rathbone, Tim
Vaughan, Dr Gerard


Rees, Rt Hon Peter (Dover)
Viggers, Peter


Rhodes James, Robert
Wakeham, Rt Hon John


Rhys Williams, Sir Brandon
Waldegrave, Hon William


Ridsdale, Sir Julian
Walker, Bill (T'side N)


Rifkind, Malcolm
Walker, Rt Hon P. (W'cester)


Rippon, Rt Hon Geoffrey
Wall, Sir Patrick


Roberts, Wyn (Conwy)
Waller, Gary


Robinson, Mark (N'port W)
Walters, Dennis


Roe, Mrs Marion
Ward, John


Rossi, Sir Hugh
Wardle, C. (Bexhill)


Rost, Peter
Warren, Kenneth


Rumbold, Mrs Angela
Watson, John


Ryder, Richard
Watts, John


Sackville, Hon Thomas
Wells, John (Maidstone)


Sainsbury, Hon Timothy
Wheeler, John


St. John-Stevas, Rt Hon N.
Whitfield, John


Sayeed, Jonathan
Wiggin, Jerry


Scott, Nicholas
Winterton, Mrs Ann


Shaw, Sir Michael (Scarb')
Winterton, Nicholas


Shelton, William (Streatham)
Wolfson, Mark


Shepherd, Colin (Hereford)
Wood, Timothy


Shepherd, Richard (Aldridge)
Woodcock, Michael


Shersby, Michael
Yeo, Tim


Silvester, Fred
Young, Sir George (Acton)


Sims, Roger



Skeet, T. H. H.
Tellers for the Noes:


Smith, Sir Dudley (Warwick)
Mr. Carol Mather and Mr. Robert Boscawen.


Smith, Tim (Beaconsfield)

Question accordingly negatived.

Question, That the proposed words be there added, put forthwith pursuant to Standing Order No. 33 (Questions on amendments):—

The House divided: Ayes 331, Noes 204.

Division No. 53]
[10.14 pm


AYES


Adley, Robert
Alison, Rt Hon Michael


Alexander, Richard
Amery, Rt Hon Julian





Amess, David
Finsberg, Geoffrey


Ancram, Michael
Fletcher, Alexander


Arnold, Tom
Fookes, Miss Janet


Ashby, David
Forman, Nigel


Aspinwall, Jack
Forsyth, Michael (Stirling)


Atkins, Rt Hon Sir H.
Fowler, Rt Hon Norman


Atkins, Robert (South Ribble)
Fox, Marcus


Atkinson, David (B'm'th E)
Franks, Cecil


Baker, Kenneth (Mole Valley)
Fraser, Rt Hon Sir Hugh


Baker, Nicholas (N Dorset)
Fraser, Peter (Angus East)


Baldry, Anthony
Freeman, Roger


Banks, Robert (Harrogate)
Fry, Peter


Batiste, Spencer
Gale, Roger


Bellingham, Henry
Galley, Roy


Bendall, Vivian
Gardner, Sir Edward (Fylde)


Bennett, Sir Frederic (T'bay)
Garel-Jones, Tristan


Benyon, William
Gilmour, Rt Hon Sir Ian


Berry, Sir Anthony
Glyn, Dr Alan


Best, Keith
Goodlad, Alastair


Bevan, David Gilroy
Gorst, John


Biffen, Rt Hon John
Gow, Ian


Biggs-Davison, Sir John
Gower, Sir Raymond


Blaker, Rt Hon Sir Peter
Grant, Sir Anthony


Body, Richard
Gregory, Conal


Bonsor, Sir Nicholas
Griffiths, E. (B'y St Edm'ds)


Bottomley, Peter
Griffiths, Peter (Portsm'th N)


Bowden, A. (Brighton K'to'n)
Grist, Ian


Bowden, Gerald (Dulwich)
Ground, Patrick


Boyson, Dr Rhodes
Gummer, John Selwyn


Braine, Sir Bernard
Hamilton, Hon A. (Epsom)


Brandon-Bravo, Martin
Hamilton, Neil (Tatton)


Bright, Graham
Hampson, Dr Keith


Brinton, Tim
Hanley, Jeremy


Brittan, Rt Hon Leon
Hannam, John


Brooke, Hon Peter
Hargreaves, Kenneth


Brown, M. (Brigg &amp; Cl'thpes)
Harvey, Robert


Browne, John
Haselhurst, Alan


Bruinvels, Peter
Hawkins, C. (High Peak)


Bryan, Sir Paul
Hayes, J.


Buchanan-Smith, Rt Hon A.
Hayhoe, Barney


Buck, Sir Antony
Hayward, Robert


Budgen, Nick
Heathcoat-Amory, David


Burt, Alistair
Heddle, John


Butcher, John
Henderson, Barry


Butler, Hon Adam
Hickmet, Richard


Butterfill, John
Hicks, Robert


Carlisle, Kenneth (Lincoln)
Higgins, Rt Hon Terence L.


Carttiss, Michael
Hill, James


Chalker, Mrs Lynda
Hind, Kenneth


Channon, Rt Hon Paul
Hirst, Michael


Chapman, Sydney
Hogg, Hon Douglas (Gr'th'm)


Chope, Christopher
Holland, Sir Philip (Gedling)


Churchill, W. S.
Holt, Richard


Clark, Dr Michael (Rochford)
Hooson, Tom


Clark, Sir W. (Croydon S)
Howard, Michael


Clarke Kenneth (Rushcliffe)
Howarth, Alan (Stratf'd-on-A)


Clegg, Sir Walter
Howarth, Gerald (Cannock)


Colvin, Michael
Howell, Rt Hon D. (G'ldford)


Coombs, Simon
Hubbard-Miles, Peter


Cope, John
Hunt, David (Wirral)


Cormack, Patrick
Hunt, John (Ravensbourne)


Couchman, James
Hunter, Andrew


Crouch, David
Hurd, Rt Hon Douglas


Currie, Mrs Edwina
Irving, Charles


Dickens, Geoffrey
Jackson, Robert


Dicks, T.
Jenkin, Rt Hon Patrick


Dorrell, Stephen
Jessel, Toby


Douglas-Hamilton, Lord J.
Johnson-Smith, Sir Geoffrey


du Cann, Rt Hon Edward
Jones, Gwilym (Cardiff N)


Dunn, Robert
Jones, Robert (W Herts)


Dykes, Hugh
Jopling, Rt Hon Michael


Eggar, Tim
Joseph, Rt Hon Sir Keith


Emery, Sir Peter
Kershaw, Sir Anthony


Evennett, David
Key, Robert


Eyre, Reginald
King, Roger (B'ham N'field)


Fairbairn, Nicholas
King, Rt Hon Tom


Fallon, Michael
Knight, Gregory (Derby N)


Farr, John
Knight, Mrs Jill (Edgbaston)


Favell, Anthony
Knowles, Michael


Fenner, Mrs Peggy
Knox, David






Lang, Ian
Ridsdale, Sir Julian


Latham, Michael
Rifkind, Malcolm


Lawler, Geoffrey
Rippon, Rt Hon Geoffrey


Lawrence, Ivan
Roberts, Wyn (Conwy)


Lawson, Rt Hon Nigel
Robinson, Mark (N'port W)


Lee, John (Pendle)
Roe, Mrs Marion


Leigh. Edward (Gainsbor'gh)
Rossi, Sir Hugh


Lennox-Boyd, Hon Mark
Rost, Peter


Lester, Jim
Rumbold, Mrs Angela


Lewis. Sir Kenneth (Stamf'd)
Ryder, Richard


Lightbown, David
Sackville, Hon Thomas


Lilley, Peter
Sainsbury, Hon Timothy


Lloyd, Ian (Havant)
St. John-Stevas, Rt Hon N.


Lloyd, Peter, (Fareham)
Sayeed, Jonathan


Lord, Michael
Shaw, Sir Michael (Scarb')


Lyell, Nicholas
Shelton, William (Streatham)


McCurley, Mrs Anna
Shepherd, Colin (Hereford)


Macfarlane, Neil
Shepherd, Richard (Aldridge)


MacGregor, John
Shersby, Michael


MacKay, Andrew (Berkshire)
Silvester, Fred


MacKay, John (Argyll &amp; Bute)
Sims, Roger


Maclean, David John.
Skeet, T. H. H.


Macmillan, Rt Hon M.
Smith, Sir Dudley (Warwick)


McNair-Wilson, M. (N'bury)
Smith, Tim (Beaconsfield)


McNair-Wilson, P. (New F'st)
Soames, Hon Nicholas


McQuarrie, Albert
Speed, Keith


Madel, David
Speller, Tony


Major, John
Spence, John


Malins, Humfrey
Spencer, D.


Malone, Gerald
Spicer, Jim (W Dorset)


Maples, John
Spicer, Michael (S Worcs)


Marland, Paul
Squire, Robin


Maude, Francis
Stanbrook, Ivor


Mawhinney, Dr Brian
Stanley, John


Maxwell-Hyslop, Robin
Steen, Anthony


Mayhew, Sir Patrick
Stern, Michael


Mellor, David
Stevens, Lewis (Nuneaton)


Merchant, Piers
Stevens, Martin (Fulham)


Miller, Hal (B grove)
Stewart, Allan (Eastwood)


Mills, Iain (Meriden)
Stewart, Andrew (Sherwood)


Mills, Sir Peter (West Devon)
Stewart, Ian (N Hertf'dshire)


Moate, Roger
Stokes, John


Monro, Sir Hector
Stradling Thomas, J.


Montgomery, Fergus
Sumberg, David


Moore, John
Tapsell, Peter


Morris, M. (N'hampton, S)
Taylor, John (Solihull)


Morrison, Hon C. (Devizes)
Taylor, Teddy (S'end E)


Moynihan, Hon C.
Tebbit, Rt Hon Norman


Murphy, Christopher
Terlezki, Stefan


Neale, Gerrard
Thatcher, Rt Hon Mrs M.


Needham, Richard
Thomas, Rt Hon Peter


Neubert, Michael
Thompson, Donald (Calder V)


Newton, Tony
Thompson, Patrick (N'ich N)


Nicholls, Patrick
Thorne, Neil (Ilford S)


Norris, Steven
Thornton, Malcolm


Onslow, Cranley
Thurnham, Peter


Oppenheim, Philip
Townend, John (Bridlington)


Oppenheim, Rt Hon Mrs S.
Townsend, Cyril D. (B'heath)


Osborn, Sir John
Tracey, Richard


Ottaway, Richard
Trippier, David


Page, Richard (Herts SW)
Twinn, Dr Ian


Parris, Matthew
van Straubenzee, Sir W.


Patten, Christopher (Bath)
Vaughan, Dr Gerard


Patten, John (Oxford)
Viggers, Peter


Pattie, Geoffrey
Wakeham, Rt Hon John


Peacock, Mrs Elizabeth
Waldegrave, Hon William


Percival, Rt Hon Sir Ian
Walden, George


Pink, R. Bonner
Walker, Bill (T'side N)


Porter, Barry
Walker, Rt Hon P. (W'cester)


Powell, William (Corby)
Wall, Sir Patrick


Powley, John
Waller, Gary


Prentice, Rt Hon Reg
Ward, John


Price, Sir David
Wardle, C. (Bexhill)


Proctor, K. Harvey
Warren, Kenneth


Raffan, Keith
Watson, John


Raison, Rt Hon Timothy
Watts, John


Rathbone, Tim
Wells, John (Maidstone)


Rees, Rt Hon Peter (Dover)
Wheeler, John


Rhodes James, Robert
Whitfield, John


Rhys Williams, Sir Brandon
Wiggin, Jerry





Winterton, Mrs Ann
Young, Sir George (Acton)


Winterton, Nicholas



Wolfson, Mark
Tellers for the Ayes:


Wood, Timothy
Mr. Carol Mather and Mr. Robert Boscawen.


Woodcock, Michael



Yeo, Tim





NOES


Abse, Leo
Forrester, John


Adams, Allen (Paisley N)
Foulkes, George


Alton, David
Fraser, J. (Norwood)


Anderson, Donald
Freeson, Rt Hon Reginald


Archer, Rt Hon Peter
Freud, Clement


Atkinson, N, (Tottenham)
Garrett, W. E.


Bagier, Gordon A. T.
George, Bruce


Banks, Tony (Newham NW)
Godman, Dr Norman


Barron, Kevin
Golding, John


Beckett, Mrs Margaret
Gould, Bryan


Beith, A. J.
Gourlay, Harry


Bell, Stuart
Hamilton, James (M'well N)


Bennett, A. (Dent'n &amp; Red'sh)
Hamilton, W. W. (Central Fife)


Bermingham, Gerald
Hardy, Peter


Bidwell, Sydney
Harman, Ms Harriet


Blair, Anthony
Harrison, Rt Hon Walter


Boyes, Roland
Hart, Rt Hon Dame Judith


Bray, Dr Jeremy
Hattersley, Rt Hon Roy


Brown, Gordon (D'f'mline E)
Healey, Rt Hon Denis


Brown, Hugh D. (Provan)
Holland, Stuart (Vauxhall)


Brown, N. (N'c'tle-u-Tyne E)
Home Robertson, John


Brown, Ron (E'burgh, Leith)
Howell, Rt Hon D. (S heath)


Bruce, Malcolm
Howells, Geraint


Caborn, Richard
Hoyle, Douglas


Callaghan, Rt Hon J.
Hughes, Mark (Durham)


Callaghan, Jim (Heyw'd &amp; M)
Hughes, Robert (Aberdeen N)


Campbell, Ian
Hughes, Roy (Newport East)


Canavan, Dennis
Hughes, Sean (Knowsley S)


Carlile, Alexander (Montg'y)
Hughes, Simon (Southwark)


Cartwright, John
Jenkins, Rt Hon Roy (Hillh'd)


Clark, Dr David (S Shields)
John, Brynmor


Clarke, Thomas
Jones, Barry (Alyn &amp; Deeside)


Clay, Robert
Kaufman, Rt Hon Gerald


Cocks, Rt Hon M. (Bristol S.)
Kennedy, Charles


Cohen, Harry
Kilfedder, James A.


Coleman, Donald
Kilroy-Silk, Robert


Concannon, Rt Hon J. D.
Kinnock, Rt Hon Neil


Cook, Robin F. (Livingston)
Lambie, David


Corbett, Robin
Lamond, James


Corbyn, Jeremy
Leadbitter, Ted


Cowans, Harry
Leighton, Ronald


Craigen, J. M.
Lewis, Ron (Carlisle)


Crowther, Stan
Lewis, Terence (Worsley)


Cunliffe, Lawrence
Litherland, Robert


Cunningham, Dr John
Lloyd, Tony (Stretford)


Dalyell, Tam
Lofthouse, Geoffrey


Davies, Rt Hon Denzil (L'lli)
Loyden, Edward


Davies, Ronald (Caerphilly)
McCartney, Hugh


Davis, Terry (B'ham, Hge H'l)
McDonald, Dr Oonagh


Deakins, Eric
McGuire, Michael


Dewar, Donald
McKay, Allen (Penistone)


Dixon, Donald
McKelvey, William


Dobson, Frank
Mackenzie, Rt Hon Gregor


Dormand, Jack
Maclennan, Robert


Douglas, Dick
McNamara, Kevin


Dubs, Alfred
McTaggart, Robert


Duffy, A. E. P.
McWilliam, John


Dunwoody, Hon Mrs G.
Madden, Max


Eadie, Alex
Marek, Dr John


Eastham, Ken
Marshall, David (Shettleston)


Edwards, R. (Whampt'n SE)
Martin, Michael


Ellis, Raymond
Mason, Rt Hon Roy


Evans, Ioan (Cynon Valley)
Maxton, John


Evans, John (St. Helens N)
Meacher, Michael


Ewing, Harry
Meadowcroft, Michael


Fatchett, Derek
Michie, William


Faulds, Andrew
Mikardo, Ian


Field, Frank (Birkenhead)
Millan, Rt Hon Bruce


Fields, T. (L'pool Broad Gn)
Miller, Dr M. S. (E Kilbride)


Fisher, Mark
Morris, Rt Hon A. (W'shawe)


Flannery, Martin
Morris, Rt Hon J. (Aberavon)


Foot, Rt Hon Michael
Nellist, David






Oakes, Rt Hon Gordon
Skinner, Dennis


O'Brien, William
Smith, C.(Isl'ton S &amp; F'bury)


O'Neill, Martin
Smith, Rt Hon J. (M'kl'ds E)


Orme, Rt Hon Stanley
Snape, Peter


Owen, Rt Hon Dr David
Spearing, Nigel


Park, George
Steel, Rt Hon David


Parry, Robert
Stewart, Rt Hon D. (W Isles)


Patchett, Terry
Stott, Roger


Pavitt, Laurie
Strang, Gavin


Pendry, Tom
Straw, Jack


Penhaligon, David
Thompson, J. (Wansbeck)


Pike, Peter
Thorne, Stan (Preston)


Powell, Raymond (Ogmore)
Tinn, James


Prescott, John
Varley, Rt Hon Eric G.


Radice, Giles
Wainwright, R.


Randall, Stuart
Wallace, James


Redmond, M.
Wardell, Gareth (Gower)


Richardson, Ms Jo
Wareing, Robert


Roberts, Ernest (Hackney N)
Weetch, Ken


Robertson, George
Welsh, Michael


Robinson, G. (Coventry NW)
White, James


Rogers, Allan
Wigley, Dafydd


Rooker, J. W.
Williams, Rt Hon A.


Ross, Ernest (Dundee W)
Wilson, Gordon


Ross, Stephen (Isle of Wight)
Winnick, David


Rowlands, Ted
Woodall, Alec


Ryman, John
Wrigglesworth, Ian


Sedgemore, Brian
Young, David (Bolton SE)


Sheerman, Barry



Sheldon, Rt Hon R.
Tellers for the Noes:


Shore, Rt Hon Peter
Mr. Austin Mitchell and Mr. Norman Hogg.


Silkin, Rt Hon J.

Question accordingly agreed to.

Mr. Speaker: forthwith declared the main Question, as amended, to be agreed to.

Resolved,
That this House reaffirms its commitment to the National Health Service and to the maintenance and improvement of standards of patient care; congratulates Her Majesty's Government on the progress made over the last four years; and endorses its efforts to ensure the best value for money spent on patient care.

Mr. David Alton: On a point of order, Mr. Speaker. While I accept that many right hon. and hon. Members tried to catch your eye during the previous debate, would the Chair be prepared to look into the problem of Liberal Members not being called today? I know that my hon. Friend the Member for Leeds, West (Mr. Meadowcroft) tried to catch your eye.

Mr. Speaker: Order. If the hon. Gentleman reflects on it, he will realise that that is not the sort of question that he should put to me now. I explained to the House that more than 40 right hon. and hon. Members wished to speak. The shorter the speeches, the more hon. Members I would have been able to call. Unfortunately, some of the speeches were not all that short.

Shoe Manufacturing

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Donald Thompson.]

Mr. Simon Hughes: On a point of order, Mr. Speaker.

Mr. Speaker: I have called the Adjournment debate, so this point of order will come out of Adjournment debate time.

Mr. Hughes: Although I accept your ruling, Mr. Speaker, that the length of speeches affects the number of participants in a debate, right hon. and hon. Members on the Liberal Bench represent more than 4 million people—[Interruption.]—who feel especially strongly about matters such as the Health Service and who would wish to have the opportunity, on a matter of such national and immediate importance, to have their voices heard. Perhaps you would further consider the matter.

Mr. Speaker: The hon. Gentleman knows that when he is called to speak, he is called as a Member of Parliament representing a constituency. The Chair does its utmost to balance the various interests in the House, and it is extremely difficult when so many hon. Members wish to speak.

Mr. David Penhaligon: rose——

Mr. Alex Carlile: On a point of order, Mr. Speaker.

Mr. Speaker: Order. I must tell hon. Members on the Liberal Bench that the Adjournment has been called and that points of order are coming out of the time of the hon. Member for Kettering (Mr. Freeman).

Mr. Carlile: On a point of order, Mr. Speaker. Were you aware that during the debate, a mere eight Labour Members took 156 minutes speaking time; a mere 10 Conservative Members took up 152 minutes speaking time; that one Nationalist and one Social Democrat were called; and that no Liberals were called and were given no time?

Mr. Speaker: I am well aware of the arithmetic.

Mr. Roger Gale: On a point of order, Mr. Speaker. Is it not necessary for hon. Members to be in the Chamber before they can be called?

Mr. Penhaligon: rose——

Mr. Malcolm Bruce: rose——

Mr. Speaker: Order. It is extremely unfair to destroy an hon. Member's Adjournment debate, but I must take the point of order.

Mr. Bruce: On a point of order, Mr. Speaker. With respect to the Chair, we feel that our intended contributions to the previous debate were destroyed. We represent nearly 4 million voters and we are the party that backed the Beveridge report that introduced the NHS. My hon. Friend the Member for Leeds, West (Mr. Meadowcroft) wished to speak on our behalf but was not called, and we feel that an injustice has been done.

Mr. Speaker: The leader of the Liberal party is present. I am sure that the House would consider it


extremely unfair if in every debate, and given that we have 650 hon. Members, the Chair had to call a member from the Social Democratic party and one from the Liberal party.

Mr. David Steel: On a point of order, Mr. Speaker. As you have referred to me, may I say that I take a very serious view of what has happened? There has long been an understanding between previous Speakers and previous leaders of the Liberal party on our proper rights in the Commons. I suggest that we allow tempers to cool and perhaps we can discuss the matter privately.

Mr. Roger Freeman: I appreciate the chance to raise the state of the men's shoe manufacturing industry, which is of particular importance to my constituency of Kettering. I regret that we have lost some time in this Adjournment debate because of the actions of some right hon. and hon. Members opposite.
The men's shoe manufacturing industry in Northamptonshire accounts for about two thirds of the national output of men's shoes. The problems of the women's shoe manufacturing industry are broadly similar, and much of what I shall say—very briefly at this hour—will relate to that industry as well.
I and my colleagues on the Conservative Back Benches welcome the appointment of my hon. Friend the Member for Rossendale and Darwen (Mr. Trippier) as the Minister responsible for the footwear industry. He has long experience of that industry, and the very least that we can expect is a sympathetic hearing.
The House need not be reminded in too much detail of the background of the contraction of the industry in the last 10 years. There were two debates in the last Parliament and the ground was well covered then. The industry has contracted by about a third in the last 10 years, and in the county of Northamptonshire that has meant a loss of about 6,000 jobs or 40 per cent. of the work force. Essentially, we have had a static domestic market and rising import penetration. That has meant real havoc for the footwear manufacturing towns.
All that has happened in spite of excellent labour relations and modest pay increases. We have a very open market, but cheaper wage costs abroad coupled with a comparatively highly valued pound in recent years have resulted in serious difficulties for our industry.
In one small town in my constituency, Rothwell, there were six factories 15 years ago and now there are two. The present state of the industry is undeniably better than in the spring. Orders are up in volume by about 11 per cent. over the period April to August. I am glad to say that the same is true of exports, which are up about 8 per cent. in volume over the same period. Imports seem to have stabilised. Some firms are experiencing great difficulty in attracting either new skilled labour or some of the old workers who were with them, who have often left the industry for good. We now have the paradoxical problem of high overtime rates and a difficulty in attracting skilled workers, although the recent London shoe fair was optimistic for the short-term.
The weaker pound, particularly in relation to the dollar, has helped, as did the strength of United Kingdom domestic sales during the summer. This relief is rather similar to the position of a man who has stopped beating

his head against a wall. The pain has stopped, but he feels a little dazed, and it is now that both the industry and the Government should make sure that the beating never occurs again. The industry has taken many dramatic steps to improve its position, but there are two areas where the Government can and should help. The first is trade relations, and the second is investment.
Three quarters of the world shoe manufacturing capacity is tightly protected. Only in the United States and western Europe are markets relatively open. We impose an 8 per cent. tariff on leather goods coming in. If the United States Government decide to accede to the pressures of their shoe manufacturers—who are putting on pressure under article 201 of their Trade Act—and restrict imports into the United States, the position will be more difficult for us, because imports into the United States will be switched from the United States to us. I hope that my hon. Friend will say that the British Government will do all that they can to persuade the United States Government not to accede to that pressure.
The industry accepts the views of the Government, which I assume are very similar to those expressed in the last Parliament. On 26 November 1982, the Minister's predecessor argued that the maintenance of an open international trading system was in Britain's best interest overall. I accept that, as do many of my hon. Friends. The Minister can help in three specific ways. In doing so, he will help an industry that has had a rough deal, in terms of both tariffs and quotas facing it abroad. First, I hope that my hon. Friend will give us an assurance that he will encourage the European Commission to bring pressure to bear on the developed countries that have comparatively high tariffs and quotas against us. We have an 8 per cent. tariff against imports, but Canada has a 22 per cent. tariff against us, in Australia it is 46·5 per cent., in Japan 27 per cent., in South Africa 30 per cent. and in New Zealand 45 per cent. These tariffs do not commend themselves to the industry as representing fair and reciprocal trade.
Secondly, I hope that the Minister will give us an assurance that he will resume the pressure that his predecessor brought to bear on Brazil to enter into a voluntary restraint agreement on its exports to us. Hong Kong and Brazil are two countries with no quota or restraint agreement. Many other countries are so covered. Thirdly, the Minister could give us an assurance that a tough negotiating stand will be taken in the next few weeks against the Comecon countries, on the imports from those countries. I should like to see the ceilings that applied recently reduced to the actual level of shipments in the past 12 months. I should not like either an increase in the ceilings, or for them to be left where they are.
In a debate on 23 February 1982, the Minister, then a Back Bencher, drew attention to the plight of the slipper industry in his constituency, due to dumping from China. He said that we in Britain are gentlemen and play cricket by the rules, whereas everyone else plays rugby. Now that his roles are now reversed, I have pleasure in reminding my hon. Friend of his words.
I turn to the question of Government aid for capital investment, factory reorganisation and product design. Many of the companies in the industry, particularly in my constituency, are family firms that employ between 100 and 200 people. Some have gone out of business, but those that remain have survived on very low profit margins, despite the better trading conditions of the past few months. They have therefore not had the resources to


invest, and have not had sufficient profits to use the generous tax allowances available for new capital investment.
The Government have done much in recent years to help the footwear industry, by encouraging the development of micro-electronic equipment and computer-aided design. I pay tribute to that, but there is a great difference between encouraging development and encouraging investment. The Shoe and Allied Trades Research Association, the industry's research body, is aided by the Government, and located—I am pleased to say—in my constituency. It has a great reputation and has done much in the past few months to pinpoint areas in which the industry could improve productivity. By improving productivity we shall be able to beat foreign competition, which can rely on cheaper wage costs than US.
How are we to achieve that aim? The Footwear Economic Development Committee, ably assisted by the British Footwear Manufacturers Federation last month delivered a recommended package to the Minister, amounting to £8·8 million of grant aid for the industry. The proposals are very similar to the small engineering firms' investment scheme which operates very successfully in the west midlands. The proposals involve one third grants over two years for new capital equipment, both for the closing room and for the back office—for financial and inventory control. Grants would also be available under the proposals for modernising buildings and investing in new buildings.
In the East Midlands 70 per cent. of our factories were built before the first world war. Therefore, we need to modernise our buildings. The proposals also involve very modest grants for companies that take on graduate designers. That is very important. We are all acutely aware of the need to control public expenditure, but the Exchequer would see a very quick return by concentrating part of its total budget on the footwear industry. It would see a return through lower social security payments, higher corporation tax payments as profits recovered and there would also be the indirect benefits of import substitution and capital expenditure programmes for the equipment suppliers.
The proposals have been warmly welcomed by the industry and by many of the constituents to whom I have spoken in recent weeks. Their confidence has been restored by the recent improvement in trading. I hope that we can persuade the Government to commit some funds to helping the next phase of modernisation, and that they will agree to repeat the experiment of 1978 and to help the industry to help itself. Indeed, I hope that my hon. Friend the Minister will have something encouraging to tell the industry tonight.

Mr. Peter Fry: My remarks must, of course be brief. However, I congratulate my neighbour and hon. Friend the Member for Kettering (Mr. Freeman) on raising this topic on the Adjournment. I join him in congratulating my hon. Friend the Minister on his appointment. No doubt he will remember that there were times during the previous Parliament when he and I

thought that we were the two lone voices speaking for the footwear industry. I am delighted that my hon. Friend the Member for Kettering has joined us.
I should like to stress the importance of selling and marketing. It is not much good producing shoes if one cannot sell them. Abroad one often hears that British manufacturers have lost their traditional markets. One reason for that is that the footwear industry is made up of fairly small firms, which, in a highly competitive world, find it very difficult to sell to all the world's markets. Indeed successive studies of the industry—going back to the study made in the late 1970s by the Economist Advisory Group—have specifically said that the industry was grossly deficient in marketing, especially the marketing of exports. The advisory group went on to say that the main stumbling blocks are:
lack of initiative, dynamism and lack of marketing professionalism".
When the Select Committee on Industry and Trade reported in 1980–81 on the subject of footwear and other industries, it said:
Too often British firms appear to lack tenacity in tackling markets.
The time has come when, if the industry is to be effective, it must realise that it is struggling and going through a time when both the market and the number of firms have been reduced to such a size that there is almost an equilibrium. However, the problems faced by the industry in the past are likely to recur. It is time that the industry recognised the weakness of having so many small and medium-sized firms. Should not the industry set up marketing agencies to which groups of firms could belong?
Such a project has been put forward in the Minister's county of Lancashire. I hope that it will happen in my county of Northamptonshire also. I hope that the Minister and the Department have taken that idea on board and will give it a fair wind. If some limited assistance is necessary to set up a modern marketing agency, I hope that the Government will not be slow in giving it.

The Under-Secretary of State for Trade and Industry (Mr. David Trippier): I am delighted to have this opportunity to reply on behalf of the Government in this debate. I have listened with great interest to the comments that my hon. Friend the Member for Kettering (Mr. Freeman) made on the proposals from the footwear economic development committee for new schemes of Government assistance specifically designed for the footwear industry. I am grateful to him for using the occasion to air his views on the proposals. I am also grateful to my hon. Friend the Member for Wellingborough (Mr. Fry) for his helpful contribution to the debate. I am pleased to see my right hon. Friend the Member for Westmorland and Lonsdale (Mr. Jopling), the Minister of Agriculture, Fisheries and Food, in the House. His interest in the footwear industry is well known—especially as he has the Kay Shoes company in his constituency.
We all share a close interest in the footwear industry's prospects and profitable development, and at the personal level I have considerable sympathy with many of the views that have been expressed. As the House knows, a high proportion of my constituents are employed in footwear manufacture, so it is with more than usual ministerial interest that I am studying the FEDC's proposals, which


reached me under a month ago. The House will not, of course, expect me to prejudge the outcome of the very careful consideration that my ministerial colleagues and I are giving to that detailed package of proposed new measures, but I would be less than frank if I did not say immediately that the proposals—and indeed the similar ones that we have received from the knitting industry, the clothing industry and the textile industry—present the Government with some very difficult decisions at a time when public expenditure constraints have rarely been tighter. The House will recognise that it would be neither equitable nor indeed sensible for the Government to consider the claims of a single industry in isolation without taking full account of others, which are in a similar position and indeed face many similar problems. All those potential claims on taxpayers' money do, however, add up to a very large sum.
Naturally, the footwear industry, like many other sectors of manufacturing, is dependent upon the prospects for the economy as a whole. In broad terms the picture is one of strong and firm recovery from the depths of the very severe world recession—and footwear, I am glad to inform the House, is not missing out.
It is opportune to engage in this debate at a time when the prospects for footwear manufacturers in this country are looking better than they have for some years. United Kingdom retail sales of footwear overall continue to be strong and imports have slowed their upward trend. Our own manufacturers' production is on an upturn and their order books are very healthy. it is also particularly encouraging to see that the rapid decline in employment that afflicted the industry in 1981 and last year has halted and that the number of jobs has recovered somewhat since its low point in January this year. Those good signs are reinforced by the very much reduced level of short-time working, down some 40 per cent. on last year, and by the even more heartening increase in overtime working, up by more than 65 per cent. in the past 12 months. Those encouraging developments should not lead us into complacency, but are nevertheless a reason for congratulation.
The picture in the men's footwear sector, to which my hon. Friend is directing attention, is also encouraging—albeit slightly less so than for the generality of the footwear industry. Following the steep fall of 14 per cent. between 1980 and 1982, production has now virtually stabilised. During the first half of this year, it was only fractionally down on the same period last year but imports have risen during the same period by a disturbing 9 per cent. compared with 1 per cent. only for the footwear market as a whole.
On the export side it is encouraging to see that at a time of buoyant home demand the industry as a whole has paid due attention to the vitally important area of exports. Total footwear exports in the first seven months of this year were 5 per cent. up on the same period the previous year—a significant achievement. Men's footwear exports, how-ever, have shown a somewhat worrying 7 per cent. drop. It is clearly invidious to attempt to draw conclusions from short-term figures such as these. Nevertheless, the comparisons appear to raise questions for which the industry, in the first place, should attempt to find the answers.
It is of course directly relevant that Italy, which has grown to a position of great strength in the footwear market in Europe, and indeed further afield, is particularly

strong in the men's footwear sector, supplying as it does a substantial 28 per cent. of the market for men's shoes in our country. It is frequently said, and, I believe, with justification, that an important cause of the problems of our footwear manufacturing industry is low-cost imports. Because of this—as one of the few exceptions to our general trade policy—we have always done all we can to provide protection for the industry against low-cost competition, not total and absolute protection, but a substantial degree of help. This is not the occasion to go into detail but about 50 per cent. of low-cost footwear imports are covered by measures initiated either by Government or by the British Footwear Manufacturers Federation, with our support.
Italian competition is, however, something completely different. I should not regard Italy as a low-cost country in this context, in general. Anyone who can show that it is trading unfairly should give me chapter and verse and I shall gladly take it up. By and large Italian competition has to be met head-on by United Kingdom footwear manufacturers. They must meet it by becoming more competitive and offering the customer in the street a well-made, stylish, highly attractive product which he or she wants to buy, and at an attractive price.
The improved fortunes of the industry, figures on which I deployed a minute or so ago, show that it has made a good start along this path. I believe that there is much more that can and must be done by the industry itself, and my hon. Friend the Member for Wellingborough suggested this. Indeed, the FEDC has spelled out precisely that message in the preamble to its aid proposals to Government. This must be right. Whatever our decision on whether to channel more taxpayers' money to the footwear manufacturing industry, the great bulk of the investment and all of the effort must emanate from within the industry itself. This in turn will be based on individual companies' commercial decisions in the light of each one's perception of developments in the market. My hon. Friend the Member for Kettering referred to the barriers faced by United Kingdom footwear exporters. We are, of course, worried about the restrictions that other countries continue to maintain while their exports enjoy relatively easy access to the United Kingdom market. I am gratified to hear that he agrees that the solution lies, not in following a policy of protectionism, but rather in pressing for the removal of these barriers. There is already some evidence that this policy has produced results. One has only to lock at the various welcome measures introduced by the Japanese—after EC pressure—to remove trade barriers on a wide range of products, to see that such a policy is paying dividends. Although the Japanese measures did not go far enough, they are, nevertheless, welcome and I can asssure my hon. Friend that the pressure will most certainly be maintained upon them to open up their market. Moreover, the Brazilians have been left in no doubt of the depth of Her Majesty's Government's—and the industry's—feelings about the unacceptable tariff disparities.
That is not to say, however, that we are at all complacent about the issue and we know that much more needs to be done. I particularly regret the fact that trade in footwear is one of the most difficult areas in which to make progress. My hon. Friend may be sure that we view the whole problem seriously and that we take every opportunity to make determined efforts, both bilaterally and though the Community, to get a better deal for the United Kingdom industry. However, changes of this


nature cannot be achieved overnight, but we shall continue with our efforts, since we believe that United Kingdom interests are better served by increasing international trade rather than risking diminishing it by starting a slide into protectionism.
I am pleased to give my hon. Friend the assurance that he seeks, that my Department will help the industry in the preparation of anti-dumping cases. If evidence of dumping and of resultant material injury to the industry can be shown, appropriate remedial action will be taken.
The FEDC projects, to which reference was made during the debate, are of course largely financed out of public funds. An important part of the funding of SATRA is also provided in this way, through my Department. Incidentally, I should not allow this opportunity to pass without congratulating the footwear industry on maintaining and supporting this excellent organisation which is, of course, based in or near my hon. Friend's constituency.
I would be very pleased to see footwear companies making full use of the public funds that are directly available to individual manufacturing companies.
As the House is fully aware, the footwear manufacturing industry contains many small firms. Considerable Government help and advice is available to such firms. An enormous amount of work has been done in this regard, much in the Kettering area.
In conclusion, let me repeat how pleased I was when this motion was tabled. It is right that hon. Members should have at regular intervals an opportunity to debate the fortunes and prospects of this important section of our manufacturing industry. My hon. Friend is to be congratulated on instigating this debate, and as regards the main thrust of his arguments I can assure him and the House as a whole that the proposals recently submitted to Government by the footwear EDC will be given the most careful consideration.

Question put and agreed to.

Adjourned accordingly at three minutes to Eleven o' clock.